Endoscopic treatment of Zenker’s Diverticulum—the modified transoral approach

Abstract

Background: Endoscopic stapling of Zenker's diverticulum is associated with a lower complication rate than open resection, but has been associated with a higher recurrence rate, likely owing to the incomplete resection of the cricopharyngeus muscle and preservation of a remnant diverticulum. Transoral resection of the diverticulum (TORD) has been reported, but no studies have evaluated long term outcomes and efficacy beyond this initial report. We describe a modified version of the technique (MTORD) which has proven safe and efficacious in our institution. Methods:The technique is performed endoscopically. A mucosal incision is created, through which the cricopharyngeus muscle is widely excised. The apex of the diverticulum is mobilized and advanced, and redundant mucosa excised. The mucosa is then repaired primarily.Results: Eighteen patients have undergone surgery to date. There have been no complications.Postoperative esophagram can confirm complete sack excision.Conclusions: MTORD is a safe and effective option for the endoscopic resection of Zenker's diverticuli.