Routine Use of Pre- and Post-procedure Impedance Planimetry to Ensure Adequate Endoscopic Therapy of Zenker’s Diverticulum.

Document Type

Conference Proceeding

Publication Date

4-2025

Publication Title

Surgical Endoscopy

Abstract

Introduction: Endoscopic treatment of Zenker’s diverticulum, a pulsion diverticulum of the esophagus, has shifted from open cricopharyngeal myotomy and rigid endoscopy to the use of flexible endoscopy. The myotomy performed at time of the procedure was considered adequate at the discretion of the surgical endoscopist. There are few studies looking at the use of the endoluminal functional lumen imaging probe (Endoflip) impedance planimetry system to assess the adequacy of myotomy at time of peroral cricopharyngeal myotomy. Our study serves to add data supporting the use of this technology for this procedure.

Methods: We conducted a retrospective review of adult patients who underwent impedance planimetry measurement pre- and post-flexible endoscopic cricopharyngeal myotomy at a single institution by a single surgical endoscopist between July 2023 and July 2024. Our primary outcome is the relative change in distensibility as measured by pre- and post-procedure impedance planimetry. Additional outcomes of interest include relative change in diameter pre- and post procedure, intraprocedural outcomes, symptom improvement at two week follow-up, and recurrence.

Results & Discussion: Twenty patients met inclusion criteria. The median age was 74 years old (59–86) and mostly female sex (n = 12, 60%). Most patients were white (n = 19, 95%) and non-Hispanic (n = 18, 90%). Median BMI was 26 kg/m 2 (17–36), average procedure length of 66 min (38–125). There were no intraoperative complications. The median absolute change in diameter was 6.7 mm (2.1–14.2) with a median relative change in diameter of 47.2%. The median absolute change in distensibility was 2.2 (0.5–4.9) with a median relative change in distensibility of 124%. All patients had a post-procedural esophagram. All patients noted improvement of symptoms at two-week follow-up. 90% of patients had their diets resumed on the same day of their procedure (n = 18) and were discharged to home. Two patients (10%) were admitted after post procedure esophagram had findings concerning for a leak. One patient was discharged on post-procedure day one after tolerating a diet trial and the other on post-procedure day two after repeat esophagram demonstrated resolution of a leak. No additional surgical intervention was required. No patients have had recurrence. Our study demonstrates that intra-procedure impedance planimetry may offer useful data to help guide surgical endoscopists on when the extent of myotomy is adequate.

Volume

39

Issue

Suppl 1

First Page

S65

Comments

SAGES Annual Meeting, March 12–15, 2025, Long Beach, CA

Last Page

S65

DOI

10.1007/s00464-025-11688-3

ISSN

1432-2218

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