Management of Zenker’s diverticulum using flexible endoscopy

Abstract

Background and AimsZenker's diverticulum is a false diverticulum through Killian's dehiscence. Symptoms include halitosis, dysphagia, regurgitation, cough, and aspiration pneumonia. Treatment options include open transcervical cricopharyngeal myotomy, trans-oral rigid endoscopic stapling, and minimally invasive endoscopic myotomy. Although open surgical techniques have historically been the criterion standard for treatment, endoscopic options have become increasingly used. We propose the use of flexible endoscopy in the management of Zenker's diverticulum.MethodsWe present a retrospective case series of 9 patients undergoing endoscopic cricopharyngeal myotomy from 2014 to 2018 using our endoscopic technique.ResultsWe demonstrate that endoscopic technique provided adequate symptomatic relief in 7 of 9 patients, with no operative adverse events.ConclusionsCricopharyngeal myotomy using flexible endoscopy is a safe and effective technique for the management of Zenker's diverticulum. Potential benefits of this approach include shorter operative times, shorter postoperative admissions, and earlier progression of diet. Initial treatment with endoscopic technique does not preclude future open repairs.

Zenker’s peroral endoscopic myotomy, or flexible or rigid septotomy for Zenker’s diverticulum: a multicenter retrospective comparison

“…A nasogastric tube, hood, endoscopic cap, or overtube were used to help visualize and stabilize the septum between the diverticulum and esophageal lumen, thus avoiding neck hyperextension. As the septum was exposed, dissection was performed by dividing the cricopharyngeus muscle [20]. For both Z-POEM and flexible endoscopic septotomy, different cutting devices and techniques have been described to incise the septum [1] (▶ Fig.…”

Divertículo de Zenker: manejo endoscópico con o sin diverticulotomo

“…El método diagnóstico más apropiado, dada su amplia disponibilidad, es el esofagograma con trago de bario con de tratamiento quirúrgico, es que es más sencilla, tiene una menor estancia hospitalaria (llegando alguna incluso a ser ambulatoria), la tasa general de éxito es hasta del 90 % y la recurrencia de síntomas aparece solo en el 10,5 % de los pacientes (32). Las complicaciones generales y la tasa de mortalidad por diverticulotomía de Zenker endoscópica flexible es de 15 % y 0 %, respectivamente, y las complicaciones más frecuentes son el enfisema cervical (5,7 %, no necesita manejo si no hay extravasación de medio), la perforación (4,0 %, usualmente se resuelve con la colocación de clips) y el sangrado (3,1 %, usualmente se controla en el mismo procedimiento) (33)(34)(35)(36).…”

Endoscopic management of Zenker’s diverticulum

“…3). [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Of these, needle knife and hook knife are the most commonly utilized. Hook knife may be especially useful as it allows pulling of the muscle fibers for precise cutting and reduces the chances of inadvertent deep injury at the bottom of the septum.…”