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ABSTRACT
Backgrounds and aims
Flexible endoscopic Zenker’s diverticulotomy (EZD) is well established as a safe and
effective technique. Due to rare but concerning complications, 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 following clinical
review. This study evaluates outcomes of this cohort compared to previously published
studies where patients are admitted for observation.
Methods
A retrospective analysis was performed of EZD procedures performed at our center using
a flexible endoscope, and in most cases, a diverticulotomy overtube, under moderate
sedation and general anesthesia. Patients were observed for two hours and discharged
if no clinical concerns. Patient comorbidities, ASA physical status, and endoscopic
complications were recorded against the ASGE severity grading system.
Results
240 EZD procedures performed between January 2015 and February 2021. Eleven (4.6%)
intraprocedural adverse events occurred: 4 perforations, 4 bleeds and one post-procedural
pain, delirium and vomiting respectively. All were recognized within the two-hour
observation period and were managed conservatively, except one patient who required
surgery. Six (2.5%) patients presented with delayed adverse events: 2 bleeds, 2 perforations
and 2 patients with post-procedural pain. All recovered uneventfully with supportive
care.
Conclusions
All significant adverse events requiring endoscopic or surgical intervention were
identified prior to discharge. Delayed adverse events occurred in 2.5% of cases, all
of which were managed supportively. Our data are comparable to published cohorts of
admitted patients, demonstrating that appropriately selected patients may be managed
as outpatients while maintaining similar safety outcomes.
Key Words
Acronyms:
ZD (Zenker’s diverticulum), EZD (Endoscopic Zenker’s diverticulotomy), ESD (Endoscopic submucosal dissection), ASA (American Society of Anesthesiologists), uCCI (Updated Charleson comorbid index), ASGE (American society of gastrointestinal endoscopy), Z-POEM (Zenker’s – per oral endoscopic myotomy), DAPT (dual antiplatelet therapy), DOAC (direct acting oral anticoagulant)To read this article in full you will need to make a payment
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Article Info
Publication History
Accepted:
September 26,
2022
Received in revised form:
September 10,
2022
Received:
August 3,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Author Contributions
Study conception and design: Scott Schoeman, Christopher Teshima
Drafting of the article: Scott Schoeman, Ryosuke Kobayashi
Critical revision of the article for intellectual content: Christopher Teshima, Jeffrey Mosko, Gary May
Final approval of the article: Scott Schoeman, Christopher Teshima
Conflicts of Interest
Scott Schoeman: No conflicts of interest
Ryosuke Kobayashi: No conflicts of interest
Christopher Teshima: No conflicts of interest
Jeffrey Mosko: No conflicts of interest
Gary May: No conflicts of interest
Norman Marcon: No conflicts of interest
Identification
Copyright
© 2022 by the American Society for Gastrointestinal Endoscopy
