Post written by Christopher Teshima, MD, PhD, from the Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, Division of Gastroenterology and Hepatology, Department of Medicine, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada.
We evaluated the outcomes of 240 patients who underwent endoscopic therapy for Zenker’s diverticulum over a 6-year study period at our center.
It has long been the standard practice at our center to perform endoscopic Zenker’s diverticulotomy (EZD) as an outpatient procedure, discharging patients after clinical assessment and without a barium swallow study.
Faculty visiting our annual live endoscopy conference would often express surprise that our patients were not electively admitted to the hospital for postprocedural observation, and it became apparent to us that overnight hospital admission was the usual practice at most centers.
Hence, we wanted to explore how our safety data compare to other centers’ published experiences.
Overall, 86% of our patients were able to successfully undergo EZD as a day procedure without admission to the hospital and without a delayed adverse event. Eleven immediate adverse events (4.6%) included 4 perforations and only 1 requiring surgical intervention. Six patients (2.5%) presented with delayed adverse events, but all were successfully managed conservatively.
These data are similar to those published from cohorts of patients who were admitted to a hospital, illustrating that EZD performed as a day procedure does not result in an increase in adverse events or worse outcomes from potentially delayed recognition of adverse events subsequent to patient discharge.
In conclusion, our data indicate that performing EZD as a day procedure without hospital admission is a safe alternative. However, it remains to be seen if similar safety data would be replicated as we increasingly perform Zenker’s peroral endoscopic myotomy in addition to traditional EZD for the treatment of Zenker’s diverticulum.
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