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Outpatient flexible endoscopic diverticulotomy for the management of Zenker’s diverticulum: a retrospective analysis of a large single-center cohort

  • Scott Schoeman
    Affiliations
    Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, Division of Gastroenterology and Hepatology, Department of Medicine, St Michael’s Hospital, Toronto, Ontario, Canada

    Division of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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  • Ryosuke Kobayashi
    Affiliations
    Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, Division of Gastroenterology and Hepatology, Department of Medicine, St Michael’s Hospital, Toronto, Ontario, Canada

    Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
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  • Norman Marcon
    Affiliations
    Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, Division of Gastroenterology and Hepatology, Department of Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
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  • Gary May
    Affiliations
    Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, Division of Gastroenterology and Hepatology, Department of Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
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  • Jeffrey Mosko
    Affiliations
    Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, Division of Gastroenterology and Hepatology, Department of Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
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  • Christopher Teshima
    Correspondence
    Reprint requests: Christopher Teshima, MD, PhD, Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St Michael’s Hospital, 30 Bond Street, Toronto, Ontario, Canada, M5B 1W8.
    Affiliations
    Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, Division of Gastroenterology and Hepatology, Department of Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
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Published:October 10, 2022DOI:https://doi.org/10.1016/j.gie.2022.09.022

      Backgrounds and Aims

      Flexible endoscopic Zenker’s diverticulotomy (EZD) is well established as a safe and effective technique. Because of rare but concerning adverse events, most centers admit patients for observation and barium swallow study. Our center routinely performs EZD as a day procedure, discharging appropriate patients on the same day after clinical review. This study evaluates outcomes of this cohort compared with previously published studies where patients are admitted for observation.

      Methods

      A retrospective analysis was performed of EZD procedures done at our center using a flexible endoscope and, in most cases, a diverticulotomy overtube with patients under moderate sedation or general anesthesia. Patients were observed for 2 hours and discharged if no clinical concerns were found. Patient comorbidities, American Society of Anesthesiologists physical status, and endoscopic adverse events were recorded against the American Society for Gastrointestinal Endoscopy severity grading system.

      Results

      Two hundred forty EZD procedures were performed between January 2015 and February 2021. Eleven (4.6%) intraprocedural adverse events occurred: 4 perforations, 4 bleeds, and 1 each postprocedural pain, delirium, and vomiting, respectively. All were recognized within the 2-hour observation period and were managed conservatively, except 1 patient who required surgery. Six patients (2.5%) presented with delayed adverse events: 2 bleeds, 2 perforations, and 2 postprocedural pain. All patients recovered uneventfully with supportive care.

      Conclusions

      All significant adverse events requiring endoscopic or surgical intervention were identified before discharge. Delayed adverse events occurred in 2.5% of cases, all of which were managed supportively. Our data are comparable with published cohorts of admitted patients, demonstrating that appropriately selected patients may be managed as outpatients while maintaining similar safety outcomes.

      Abbreviations:

      EZD (endoscopic Zenker’s diverticulotomy), ZD (Zenker’s diverticulum)
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