Per-Oral Endoscopic Septotomy versus Flexible Endoscopy Septotomy for Short-Septum Zenker’s Diverticulum
Bibliographic record
Abstract
Aims Treatment of short-septum Zenker’s diverticulum (SS-ZD) is challenging because the limited anatomical space restricts operating area and scope maneuverability. Recently, per-oral endoscopic septotomy (POES) has emerged as a third-space method for treating of SS-ZD, providing the immediate access to the cricopharyngeal muscle via a submucosal tunneling approach, and allowing the mucosal flap sparing, which facilitates clip closure after dissection. This study aims to compare the effectiveness and safety of per-oral endoscopic septotomy (POES) with traditional flexible endoscopic septotomy (FES) for the treatment of symptomatic patients with SS-ZD. Methods All consecutive patients with symptomatic SS-ZD treated by FES (from 2015 to 2018) and POES (from 2019 to 2022) at a high-volume advance therapeutic endoscopy center were included. SS-ZD were defined as ZD with septa < 20mm. Main outcomes were the rates of technical success, adverse events (AEs) – such as bleeding and perforation – clinical success and recurrence at 12 months. Clinical success was defined as a Dakkak – Bennett score < 1, while recurrence as the new onset of dysphagia after treatment, confirmed by a residual septum at barium esophagogram/esophagogastroduodenoscopy requiring retreatment. A sensitivity analysis was conducted using a propensity score matching [ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ] [ 6 ] [ 7 ]. Results A total of 94 patients (63.8% male; mean age 72.7 + 10.7 years) underwent septotomy with a men hospital stay of 0.3 days. Technical success was achieved in 100% of POES cases (n=55) and 97.4% of FES cases (n=38; p=0.8). The single technical failure in the FES group (2.6%; n=1) was attributed to intraprocedural bleeding. AEs occurred in 5.4% of POES cases (n=3: two bleedings and one perforation) and 5.1% of FES cases (n=2: one bleeding and one perforation), all successfully managed endoscopically (p=0.9). In the POES group, the three AEs comprised two delayed bleedings, occurring more than 24 hours after discharge, and one perforation, which was managed conservatively with nasogastric tube placement, broad-spectrum antibiotics, and fasting. In the FES group, AEs included one intraprocedural bleeding, necessitating placement of three TTSCs and resulting in technical failure, and one perforation, which was managed endoscopically. The propensity score matching-based sensitivity analysis confirmed no statistically significant differences in the main outcomes between the two groups (28 FES vs 28 POES; p=n.s.). Conclusions POES and FES are both effective and safe for managing SS-ZD, offering comparable technical and clinical outcomes with low adverse event and recurrence rates. These findings support the use of either approach, with the choice driven by institutional expertise. Randomized controlled trials are warranted to validate these results. Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".