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01-07-2021 | Endoscopy | 2020 SAGES Oral

Endoscopic mucosal incision and muscle interruption (MIMI) for the treatment of Zenker’s diverticulum

Authors: Michael J. Klingler, Joshua P. Landreneau, Andrew T. Strong, Juan S. Barajas-Gamboa, Christine Tat, Chao Tu, Alisan Fathalizadeh, Matthew Kroh, John Rodriguez, Madhusudhan R. Sanaka, Jeffrey Ponsky

Published in: Surgical Endoscopy | Issue 7/2021

Abstract

Background

In peroral endoscopic myotomy for Zenker’s diverticulum (Z-POEM), the cricopharyngeus muscle is divided within a submucosal tunnel started in the hypopharynx. We aimed to evaluate the safety and preliminary outcomes in patients who underwent a modified version of the Z-POEM where the tunnel is made directly overlying the cricopharyngeus, the mucosal incision and muscular interruption (MIMI) approach, and to compare these with patients who underwent a non-tunneled flexible endoscopic approach.

Methods

All patients with ZD who were treated by flexible endoscopy at our institution between January 2015 and February 2020 were identified by a retrospective chart review. Dysphagia symptoms were assessed using a validated scoring system.

Results

Nineteen patients with ZD underwent MIMI (mean age 76.1 years, 68.1% male) and seven patients underwent non-tunneled flexible endoscopic approach (mean age 64.4 years, 85.7% male) during the study period. Mean ZD size was 2.8 cm in the MIMI group and 1.9 cm in the non-tunneled group (p = 0.03). Clinical success was achieved in 17/19(89.5%) MIMI patients and 7/7(100%) of non-tunneled flexible endoscopic patients (p = 0.101). Dysphagia scores improved in both groups, although this difference was only significant in the MIMI group (p ≤ 0.001). Recurrence occurred in 2/17(11.7%) MIMI patients and 3/7(42.9%) non-tunneled flexible endoscopic patients (p = 0.096). There were 4 complications, including one pharyngeal perforation requiring open surgical repair in a patient with a small ZD with an associated cricopharyngeal bar in the MIMI group. Median length of follow-up was 290 [142; 465] days in the MIMI group and 1056 [258; 1206] days in the non-tunneled group (p = 0.094).

Conclusions

MIMI is a technically feasible and effective treatment for ZD. Care should be taken in patients with a cricopharyngeal bar and small ZD, as this may increase the risk of perforation. Larger studies with long-term follow-up are needed to determine if MIMI reduces the risk of symptom recurrence when compared to non-tunneled flexible endoscopic approaches.

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Title: Endoscopic mucosal incision and muscle interruption (MIMI) for the treatment of Zenker’s diverticulum
Authors: Michael J. Klingler
Joshua P. Landreneau
Andrew T. Strong
Juan S. Barajas-Gamboa
Christine Tat
Chao Tu
Alisan Fathalizadeh
Matthew Kroh
John Rodriguez
Madhusudhan R. Sanaka
Jeffrey Ponsky
Publication date: 01-07-2021
Publisher: Springer US
Keywords: Endoscopy
Zenker's Diverticulum
Incision
Dysphagia
Dysphagia
Dysphagia
Published in: Surgical Endoscopy / Issue 7/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-07861-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Endoscopic mucosal incision and muscle interruption (MIMI) for the treatment of Zenker’s diverticulum

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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