S1054 The Role of Peroral Endoscopic Myotomy in the Management of Zenker’s Diverticulum: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Introduction: Zenker’s diverticulum (ZD) causing dysphagia in older adults is a false pulsion diverticulum. Zenker’s peroral endoscopic myotomy (Z-POEM), a novel approach utilizing the submucosal layer to fully visualize and cut the septum, offers a minimally invasive alternative to conventional endoscopic septotomy. This meta-analysis aimed to assess the efficacy and safety of the POEM technique in ZD management. Methods: The electronic databases including PubMed, Cochrane Library, and ScienceDirect were searched from inception to January 2025. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The pooled analysis was conducted under the random effects model in R version 4.2.3 and employed the “metaprop” package. The primary and secondary outcomes of interest were clinical success, technical success, symptom recurrence, and adverse events. The quality of studies was judged by the Newcastle Ottawa Scale. Publication bias was assessed through visual inspection of the funnel plots. A sensitivity analysis was conducted to investigate heterogeneity. Results: Twenty studies pooling a total of 713 patients were included in this meta-analysis. The pooled clinical success rate was 93% (95% confidence interval [CI] 89-96%; I2 = 9.5%). The technical success rate was 99% (95% CI 97-100%; I2 = 0%). Regarding the recurrence of the symptoms, the pooled rate was 6% (95% CI 4-11%; I2 = 1.3%) whereas the pooled rate of adverse events was 7% (95% CI 5-11%; I2 = 0%). Conclusion: Zenker's peroral endoscopic myotomy demonstrates high clinical and technical success rates with low rates of symptom recurrence and adverse events establishing it as a safe and effective minimally invasive approach for managing Zenker’s diverticulum. These findings highlight Z-POEM's potential as a superior alternative to conventional endoscopic techniques in older adults.
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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 | 0.015 | 0.032 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.020 | 0.038 |
| Bibliometrics | 0.008 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 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".