Does residual wall size or technique matter in the treatment of Zenker's diverticulum?

Shah, Rupali N.; Slaughter, Keimun A.; Fedore, Lauren; Huang, Benjamin; Deal, Allison M.; Buckmire, Robert A.

doi:10.1002/lary.25975

Cited by 25 publications

(27 citation statements)

References 17 publications

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“…Partial septotomy in diverticula bigger than 5 cm proposed by some surgeons even if results in successful myotomy still fails to completely remove the septum, which in future may require one or more endoscopic interventions. [ 4 , 6 , 16 ]…”

Section: Discussionmentioning

confidence: 99%

Zenker diverticulum

et al. 2018

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The purpose of this retrospective study is to show that transcervical diverticulectomy (TD) in treatment of Zenker diverticulum (ZD) can still be a first choice procedure in selected patients and in experienced hands its safety might be compared to the minimally invasive endoscopic diverticulostomy.The study cohort consisted of 44 patients (18 male, 26 female) operated for (ZD). All the patients underwent open diverticulectomy. The decision to choose open surgical repair depended on surgical risk, age of the patient, size of the diverticular septum (the distance between the top of the diverticulum and its bottom on barium study), and patient's preference.Mean age of patients was 64.6 ± 11.9 years; range: 26 to 88 years. A total of 36.4% out of them finished 70 years. Postoperative mortality was nil. Two major complications (4.5%) requiring surgical intervention occurred: leak and hematoma.Data were analyzed by t test for independent samples using Statistica 12.5 software. P value <0.05 was considered statistically significant.Surgical treatment of patients with ZD should be individualized. Large Zenker diverticula with the septum longer than 6 cm should preferably be resected through an open approach because it is not possible to remove the septum completely during one-step endoscopic procedure and diverticulostomy creates a weak and large common cavity in the esophagus. Surgical repair is effective for all sizes of diverticula, but its most serious complications such as leakage or laryngeal nerve injury should be considered, especially in elderly patients with comorbidities. However, age alone should not be the main criterion if choosing the treatment option.

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Section: Discussionmentioning

confidence: 99%

Zenker diverticulum

et al. 2018

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“…Endoscopic stapler diverticulotomy is a popular approach for Zenker’s diverticulum due to its low morbidity, but studies have shown significant persistent dysphagia and recurrence up to 20%. 1,2 Shah et al 2 showed that the diverticulum common wall is significantly larger after stapler diverticulotomy compared to open approaches. These existing studies indicate the possibility that there is an association between the persistent diverticulum and the increased recurrence seen in the endoscopic stapler approach.…”

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confidence: 99%

The Plication Technique to Enhance the Endoscopic Approach to Zenker's Diverticulum

Ching

Kahane

Reeve

et al. 2018

Otolaryngol.--head neck surg.

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Endoscopic stapler approaches to Zenker's diverticulum often yield a persistent diverticulum and recurrent dysphagia up to 20%. A novel technique to reduce the postoperative diverticulum is described. Eight consecutive patients with Zenker's diverticulum who underwent endoscopic stapler diverticulotomy had adjunctive endoscopic plication of the diverticulum wall to functionally reduce the residual diverticulum size. On postoperative esophagram, there was no visible diverticulum in 4 of 7 patients (57%). The remaining 3 patients had a reduction in common wall of 76%, 50%, and 40% with a mean postoperative size of 1.0 cm. All patients had resolution or significant improvement in dysphagia. There were no complications or recurrences at a mean follow-up of 6.3 months. As an adjunct to endoscopic treatment of Zenker's diverticulum, the plication technique can reduce diverticulum size. Further studies will determine if the plication technique affects long-term recurrence of endoscopic stapler approaches.

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“…However, given the elderly and frail population included in our study, with 20 % malnourished patients and 84 % with severe cardiovascular comorbid conditions, we observed 10 % medical complications of the anesthesia, of which 5 % were severe. In a retrospective analysis of 76 patients treated surgically or endoscopically for ZD, Shah et al showed endoscopic staplerassisted diverticulotomy to be associated with a longer residual diverticular wall and with higher risk of recurrent disease [14]. Similarly, Costamagna et al, in a study of 89 patients, correlated risk of recurrent disease with a < 25 mm length of septotomy [8].…”

Section: Discussionmentioning

confidence: 98%

Endoscopic treatment of Zenkerʼs diverticulum by complete septotomy: initial experience in 19 patients

et al. 2020

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Background and study aims Endoscopic treatment of Zenker’s Diverticulum (ZD) using a flexible endoscope and a diverticuloscope consists of myotomy of the cricopharyngeus muscle, sparing the lower part of the diverticular septum. However, recurrence occurs in up to 54 % of patients at 4 years. We assessed the feasibility and safety of a complete septotomy in endoscopic treatment of ZD. Patients and methods We conducted a retrospective analysis of a prospectively collected database at a single referral center. All consecutive patients treated by complete resection of the diverticular wall were included. The endoscopic technique used a distal attachment cap and division of the ZD septum using a Dual Knife or a Triangle Tip knife in endocut mode, until the esophageal muscularis propria was seen and no residual diverticulum remained. Symptoms were evaluated using the Augsburger questionnaire. Results Nineteen patients, 10 of whom were men with mean age 79 ± 12 years, were treated by complete septotomy for a symptomatic ZD with a median size of 2.5 cm (range 1–5 cm). The clinical success rate was 100 % and the complication rate was 10 % (one pneumonia and one atrial fibrillation). Median hospital stay was 2 days (range 1–3 days). On Day 1 esophagogram, no extraesophageal contrast leakage was seen, periesophageal CO2 was still visible in two patients, and complete ZD regression was seen in 63 % of patients. The 6-month clinical success rate was 100 %, with two patients lost to follow-up, and a median symptom score of 0 (range 0–4). After a mean ± SD follow-up of 9 ± 5 months, the clinical success rate was 94 % (16/17). Conclusion Complete endoscopic septotomy is a feasible and safe therapeutic modality in patients with symptomatic ZD that does not require use of a diverticuloscope, and with good short-term efficacy. The complete regression of the diverticulum observed on Day 1 in 63 % of patients could be a marker of long-term clinical success.

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Does residual wall size or technique matter in the treatment of Zenker's diverticulum?

Abstract: 4 Laryngoscope, 126:2475-2479, 2016.

Cited by 25 publications

References 17 publications

Zenker diverticulum

Zenker diverticulum

The Plication Technique to Enhance the Endoscopic Approach to Zenker's Diverticulum

Endoscopic treatment of Zenkerʼs diverticulum by complete septotomy: initial experience in 19 patients

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