Endoscopy
Signal score, how each part rates
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See the full rubric →Peroral Endoscopic Myotomy versus Flexible Endoscopic Septotomy for Zenker's Diverticulum: A Cost-Effectiveness Analysis.
Clinical takeawayFor short-term (12-month) cost-effectiveness in older patients (typically 70-year-old), prefer FES over Z-POEM in Zenker's diverticulum. For longer-term (24-month) outcomes, consider Z-POEM due to its durability and reduced reintervention needs, but weigh against higher upfront costs.
What it foundIn a 70-year-old patient with Zenker's diverticulum, Z-POEM had higher costs ($5,706 more) and modest incremental effectiveness (0.01461 QALYs) vs FES over 12 months, with an ICER of $390,344/QALY, exceeding WTP thresholds; at 24 months, Z-POEM became cost-effective due to lower recurrence and reduced need for reintervention, despite higher upfront costs.
ContextRefines current practice by quantifying the cost-effectiveness trade-offs between Z-POEM and FES in older patients, highlighting the time horizon and upfront costs as critical factors in decision-making.
Refinessuggested applicable standard· ASGE 2018 + ESGE 2017 Zenker + Z-POEM consensus
Decision at stakethe choice between Z-POEM and FES for symptomatic Zenker's diverticula ≥2 cm
ASGE 2018 + ESGE 2017 Zenker + Z-POEM consensus · reviewed 2026-05-09Confirm suspected Zenker's diverticulum with a video barium swallow FIRST (never blind EGD), sizing the pouch as small (<2 cm), medium (2-4 cm), or large (>4 cm). Manage symptomatic small (<2 cm) diverticula with dietary modification, postprandial neck flexion, and monitoring. For symptomatic diverticula ≥2 cm, offer intervention, endoscopic Z-POEM (emerging gold standard) or flexible endoscopic septum division when anatomy is favorable, with open transcervical cricopharyngeal myotomy plus diverticulectomy reserved for very large or failed-endoscopic cases; botulinum toxin injection is an alternative for poor surgical candidates.
Sonaiya S … Adler DG · Gastrointestinal Endoscopy · IF 8.0 · PubMed ↗