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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 10, 2022
Accepted:
September 26,
2022
Received:
August 3,
2022
Footnotes
DISCLOSURE: All authors disclosed no financial relationships.
Identification
Copyright
© 2023 by the American Society for Gastrointestinal Endoscopy
