Per Oral Endoscopic Myotomy (POEM) for Zenker's Diverticulum
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Author: David Schwartzberg
Published:
Specialties: Endoscopy, General Surgery
Schools: New York University Langone Medical Center
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Loading...In contrast to major thoracic operations, per oral endoscopic myotomy for Zenker's diverticulum offers the possiblity to resect a symptomatic Zenker's under monitored anesthesia care (MAC) for patients to ill to undergo general anesthesia. Patients have similar functional results when compared to small Zenker's treated with traditional operative approaches.
Procedure
Per Oral Endoscopic Myotomy for Zenker's Diverticulum
Indications
Small (<4cm) symptomatic Zenker's diverticulum. Symptoms include halitosis, food intolerance, regurgitation or aspiration.
Contraindications
Coagulopathy, inability to tolerate endoscopy or anesthesia
Instrumentation
Setup
Endoscopy with monitored anesthesia care (MAC)
Preoperative Workup
Upper gastrointestinal series and/or endoscopy to document a small Zenke's diverticulum, basic labs including coagulation profile
Anatomy and Landmarks
Esophagus, cricopharyngeus, Zenker's diverticulum, longitudinal and circular layers of the esophagus
Advantages/Disadvantages
Advantages: patient does not have to undergo general anesthesia and avoids the morbidity associated with a thoracotomy. Disadvantages: cannot operatively correct large symptomatic Zenker's diverticulum, esophageal perforation
Complications/Risks
Aspiration, bleeding, infection, incomplete myotomy, esophageal perforation
Disclosure of Conflicts
None
Acknowledgements
Monmouth Medical Center, NJ Department of Surgery & Gastroenterology
References
POEM-Based Endoscopic Treatment of Zenker's Diverticulum: Minimal Incision Cricopharyngeal Myotomy (cpm) http://meetings.ssat.com/abstracts/2013/Su1623.cgi
Luke Mccrone*1, Kondal R. Kyanam Kabir Baig2, Victoria Gomez2, John D. Casler3, Timothy a. Woodward2
1Internal Medicine, Mayo Clinic Florida, Jacksonville, FL; 2Gastroenterology, Mayo Clinic Florida, Jacksonville, FL; 3Otorhinolaryngology, Mayo Clinic Florida, Jacksonville, FL
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