Safety of same day discharge after Zenker's diverticulum peroral endoscopic myotomy

There are limited data on the safety of same-day discharge (SDD) following peroral endoscopic myotomy for Zenker's diverticulum (Z-POEM). Our aim is to assess the frequency and etiology of emergency department (ED) visits or hospital admissions after SDD after Z-POEM.

Patients at our institution between 02/2020 and 08/2023 who had SDD after Z-POEM were identified. Criteria for SDD were: 1)no procedure-related serious adverse event; 2)post-POEM esophagram without leak; 3)stable vital signs; 4)ability to take liquids; 5)pain controlled without IV analgesia; 6)social support for transit to ED; 7)ASA class I-III. Relevant post-procedure events, ED visits and hospitalizations within 30 days were reported. A causative relationship between Z-POEM and ED visits and hospitalizations was assigned by consensus.

39 Z-POEMs were performed, and 26 (67 %) patients (58 % male, median age 72 years) had SDD. Mean ZD diameter was 29±14 mm and mean baseline Dakkak and Bennett's score was 2.9 ± 0.9. Within 30 days of Z-POEM, two(7.7 %) ED visits occurred 13 days and 9 days post-procedure for a COPD exacerbation(n = 1) and pneumonia(n = 1), respectively. Both patients were discharged without admission and only the visit for pneumonia was considered related to Z-POEM.

Eligible patients who follow and fulfill a strict protocol after Z-POEM may be safely discharged the same day of the procedure.