{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T21:55:44Z","timestamp":1792533344944,"version":"4.5.0"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2024,8,19]],"date-time":"2024-08-19T00:00:00Z","timestamp":1724025600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,8,19]],"date-time":"2024-08-19T00:00:00Z","timestamp":1724025600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Endosc"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Minimally invasive endoscopic options are safe and effective alternatives to surgery for the treatment of symptomatic Zenker\u2019s diverticulum (ZD). However, there is no consensus on the gold-standard approach. We compared the safety and efficacy of Zenker\u2019s peroral endoscopic myotomy (Z-POEM), flexible diverticulotomy (FD), and rigid diverticulotomy (RD) for the management of ZD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients undergoing treatment for ZD at three UK tertiary referral centres were identified and analysed between 2013 and 2023. Patient demographics, procedural details, clinical success, and 30-day adverse events (AE) were recorded. The primary outcomes were technical and clinical success defined as a fall in Dakkak and Bennett dysphagia score to\u2009\u2264\u20091 without re-intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There was no difference in baseline characteristics amongst 126 patients undergoing intervention (50 RD, 31 FD, 45 Z-POEM). Technical success for RD, FD, and Z-POEM was 80%, 100%, and 100%, respectively (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Over a mean follow-up of 11.0 months (95% CI 8.2\u201313.9), clinical success amongst those treated was 85.3% (RD), 74.1% (FD), and 83.7% (Z-POEM;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.48) with recurrence in 17.2% (RD), 20.0% (FD), and 8.3% (Z-POEM;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.50). AEs were equivalent between groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.98). During this time, 11 patients underwent surgical myotomy with low clinical success (36.4%) and high morbidity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Endoscopic options for the treatment of ZD show equivalent rates of success, but failed RD often led to open myotomy with worse outcomes. Flexible endoscopic modalities are both safe and highly effective treatments that may be considered first-line in experienced centres and should be offered before surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00464-024-11164-4","type":"journal-article","created":{"date-parts":[[2024,8,19]],"date-time":"2024-08-19T12:02:15Z","timestamp":1724068935000},"page":"5842-5850","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["The safety and efficacy of endoscopic approaches for the management of Zenker\u2019s diverticulum: a multicentre retrospective study"],"prefix":"10.1007","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2058-3162","authenticated-orcid":false,"given":"Benjamin","family":"Norton","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Siggens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Apostolis","family":"Papaefthymiou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Telese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Duku","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Murino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gavin","family":"Johnson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Murray","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Borzoueh","family":"Mohammadi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muntzer","family":"Mughal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raf","family":"Bisschops","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pradeep","family":"Bhandari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Birchall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rehan","family":"Haidry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,8,19]]},"reference":[{"issue":"4","key":"11164_CR1","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1111\/den.13035","volume":"30","author":"S Ishaq","year":"2018","unstructured":"Ishaq S et al (2018) New and emerging techniques for endoscopic treatment of Zenker\u2019s diverticulum: state-of-the-art review. Dig Endosc 30(4):449\u2013460","journal-title":"Dig Endosc"},{"issue":"4","key":"11164_CR2","first-page":"219","volume":"33","author":"A Bizzotto","year":"2013","unstructured":"Bizzotto A et al (2013) Zenker\u2019s diverticulum: exploring treatment options. Acta Otorhinolaryngol Ital 33(4):219\u2013229","journal-title":"Acta Otorhinolaryngol Ital"},{"issue":"910","key":"11164_CR3","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1136\/pmj.77.910.506","volume":"77","author":"MA Siddiq","year":"2001","unstructured":"Siddiq MA, Sood S, Strachan D (2001) Pharyngeal pouch (Zenker\u2019s diverticulum). Postgrad Med J 77(910):506\u2013511","journal-title":"Postgrad Med J"},{"issue":"5","key":"11164_CR4","doi-asserted-by":"publisher","first-page":"725","DOI":"10.1177\/0194599811435304","volume":"146","author":"K Mantsopoulos","year":"2012","unstructured":"Mantsopoulos K et al (2012) Evaluation of the different transcervical approaches for Zenker diverticulum. Otolaryngol Head Neck Surg 146(5):725\u2013729","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"3","key":"11164_CR5","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1159\/000351433","volume":"30","author":"Y Yuan","year":"2013","unstructured":"Yuan Y et al (2013) Surgical treatment of Zenker\u2019s diverticulum. Dig Surg 30(3):207\u2013218","journal-title":"Dig Surg"},{"issue":"4","key":"11164_CR6","doi-asserted-by":"publisher","first-page":"1167","DOI":"10.3748\/wjg.v21.i4.1167","volume":"21","author":"L Bonavina","year":"2015","unstructured":"Bonavina L et al (2015) Long-term outcome and quality of life after transoral stapling for Zenker diverticulum. World J Gastroenterol 21(4):1167\u20131172","journal-title":"World J Gastroenterol"},{"issue":"6","key":"11164_CR7","doi-asserted-by":"publisher","first-page":"1076","DOI":"10.1016\/j.gie.2016.01.039","volume":"83","author":"S Ishaq","year":"2016","unstructured":"Ishaq S et al (2016) Flexible endoscopic treatment for Zenker\u2019s diverticulum: a systematic review and meta-analysis. Gastrointest Endosc 83(6):1076\u20131089","journal-title":"Gastrointest Endosc"},{"issue":"1","key":"11164_CR8","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1007\/s00464-019-06833-8","volume":"34","author":"H Shiwaku","year":"2020","unstructured":"Shiwaku H et al (2020) Multicenter collaborative retrospective evaluation of peroral endoscopic myotomy for esophageal achalasia: analysis of data from more than 1300 patients at eight facilities in Japan. Surg Endosc 34(1):464\u2013468","journal-title":"Surg Endosc"},{"issue":"6","key":"11164_CR9","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1055\/s-0043-105574","volume":"49","author":"B Brieau","year":"2017","unstructured":"Brieau B et al (2017) Submucosal tunneling endoscopic septum division for Zenker\u2019s diverticulum: a reproducible procedure for endoscopists who perform peroral endoscopic myotomy. Endoscopy 49(6):613\u2013614","journal-title":"Endoscopy"},{"issue":"1S","key":"11164_CR10","doi-asserted-by":"publisher","first-page":"e78","DOI":"10.1097\/MEG.0000000000002318","volume":"33","author":"M Spadaccini","year":"2021","unstructured":"Spadaccini M et al (2021) Submucosal tunnelling techniques for Zenker\u2019s diverticulum: a systematic review of early outcomes with pooled analysis. Eur J Gastroenterol Hepatol 33(1S):e78\u2013e83","journal-title":"Eur J Gastroenterol Hepatol"},{"issue":"4","key":"11164_CR11","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1055\/a-1518-7223","volume":"54","author":"SS Al Ghamdi","year":"2022","unstructured":"Al Ghamdi SS et al (2022) Zenker\u2019s peroral endoscopic myotomy, or flexible or rigid septotomy for Zenker\u2019s diverticulum: a multicenter retrospective comparison. Endoscopy 54(4):345\u2013351","journal-title":"Endoscopy"},{"issue":"4","key":"11164_CR12","doi-asserted-by":"publisher","first-page":"962","DOI":"10.1002\/ohn.318","volume":"169","author":"KP Wallerius","year":"2023","unstructured":"Wallerius KP et al (2023) Comparing open versus rigid endoscopic and flexible endoscopic techniques for the treatment of Zenker\u2019s diverticulum. Otolaryngol Head Neck Surg 169(4):962\u2013970","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"8","key":"11164_CR13","volume":"15","author":"DP Cadena Aguirre","year":"2023","unstructured":"Cadena Aguirre DP et al (2023) Flexible endoscopy versus rigid endoscopy or surgery for the management of Zenker\u2019s diverticulum: a systematic review and meta-analysis. Cureus 15(8):e43021","journal-title":"Cureus"},{"issue":"9","key":"11164_CR14","doi-asserted-by":"publisher","first-page":"6818","DOI":"10.1007\/s00464-023-10136-4","volume":"37","author":"E Swei","year":"2023","unstructured":"Swei E et al (2023) Comparison of Zenker\u2019s per-oral endoscopic myotomy (Z-POEM) with standard flexible endoscopic septotomy for Zenker\u2019s diverticulum: a prospective study with 2-year follow-up. Surg Endosc 37(9):6818\u20136823","journal-title":"Surg Endosc"},{"issue":"6","key":"11164_CR15","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1016\/j.gie.2019.03.1095","volume":"89","author":"F Aslan","year":"2019","unstructured":"Aslan F et al (2019) Tu1951 a new technique in treatment of Zenker diverticulum: submucosal tunneling endoscopic septum division (Z-POEM) versus classic endoscopic septomyotomy techniques. Gastrointest Endosc 89(6):629","journal-title":"Gastrointest Endosc"},{"issue":"6","key":"11164_CR16","doi-asserted-by":"publisher","first-page":"AB450","DOI":"10.1016\/j.gie.2019.03.1262","volume":"89","author":"PN Desai","year":"2019","unstructured":"Desai PN, Kabrawala MV (2019) Mo1175 submucosal tunnelling endoscopic septum division for Zenker\u2019s diverticulum (Z POEM): a new emerging technique compared to conventional flexible endoscpic septotomy. Gastrointest Endosc 89(6):AB450","journal-title":"Gastrointest Endosc"}],"container-title":["Surgical Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-024-11164-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00464-024-11164-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-024-11164-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T20:03:55Z","timestamp":1728331435000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00464-024-11164-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,19]]},"references-count":16,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2024,10]]}},"alternative-id":["11164"],"URL":"https:\/\/doi.org\/10.1007\/s00464-024-11164-4","relation":{},"ISSN":["0930-2794","1432-2218"],"issn-type":[{"value":"0930-2794","type":"print"},{"value":"1432-2218","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,19]]},"assertion":[{"value":"16 April 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 August 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 August 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Dr Benjamin Norton, Ms Katie Siggens, Dr Apostolis Papaefthymiou, Dr Andrea Telese, Ms Margaret Duku, Dr Alberto Murino, Dr Gavin Johnson, Dr Charles Murray, Mr Borzoueh Mohammadi, Mr Muntzer Mughal, Dr Raf Bisschops, Prof. Pradeep Bhandari, Prof. Martin Birchall, and Dr Rehan Haidry have no relevant conflicts of interest to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}},{"value":"This was a retrospective analysis of routine patient care, so formal ethical opinion was not required.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent was obtained from a small number of patients who are part of a prospective POEM registry. Their study data were collected and managed through the CCL BioResource, which is a prospective, longitudinal cohort study funded and sponsored by CCL.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}