Flexible endoscopic treatment for Zenker's diverticulum - experience on 31 patients

J Gastrointestin Liver Dis. 2018 Sep;27(3):227-231. doi: 10.15403/jgld.2014.1121.273.zen.

Abstract

Background and aims: The aim of this study is to present the experience of our center over the last 8 years in a series of patients with Zenker's diverticulum (ZD), treated using an endoscopic, minimally invasive procedure.

Methods: We retrospectively included 31 patients with a previously established diagnosis of ZD based on endoscopic and oral contrast examinations. Patients' age, comorbidities, size of the diverticulum or previous endoscopic treatment were not considered exclusion criteria. A soft, flexible diverticuloscope to expose the septum and a dual knife for "cutting" the diverticular septum were used. We analyzed the short term efficacy based on symptomatic relief and occurrence of side effects, and long term efficiency at 6 and 12 months by clinical assessment, upper gastrointestinal endoscopy and oral contrast media passage.

Results: Patients had a mean age of 67 years (range 42-86); 55% of them were male. All patients reported symptom relief after the procedure. A decrease of more than 70% from the initial size of the diverticulum was noted. There were 3 cases (9.67%) of intraprocedural hemorrhage, endoscopically managed. No serious post-procedural complications and no mortality were reported. The mean procedural time was 21.87 minutes (range 15-25 minutes). Average hospitalization was 2.5 days. Five patients developed recurrence and needed a second session of endoscopic treatment for achieving complete myotomy.

Conclusions: Endoscopic management for ZD was efficient and safe in our series of patients. A short hospitalization period was required.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Equipment Design
  • Esophagoscopy / adverse effects
  • Esophagoscopy / instrumentation*
  • Esophagoscopy / methods
  • Female
  • Gastroscopes*
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Myotomy / adverse effects
  • Myotomy / instrumentation*
  • Myotomy / methods
  • Operative Time
  • Pliability
  • Postoperative Complications / etiology
  • Recurrence
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Zenker Diverticulum / diagnosis
  • Zenker Diverticulum / surgery*