Treatment of Zenker’s diverticulum through a flexible endoscope with a transparent oblique-end hood attached to the tip and a monopolar forceps

Abstract

This endoscopic technique is an efficient, safe and minimally invasive method for the treatment of Zenker's diverticulum. General anesthesia is not necessary and oral feeding can be resumed the next day. In view of the excellent results and minimal complications, it can be considered a safe alternative for the treatment of Zenker's diverticulum.

Flexible Endoscopic Management of Zenker Diverticulum: The Mayo Clinic Experience

“…Bleeding occurred in 0% to 14% of patients, and subcutaneous or mediastinal emphysema (due to esophageal perforation) occurred in 0% to 23% of patients. 1,5,[7][8][9]12,14 Our experience with flexible endoscopic CP myotomy has yielded promising results. Procedure success as defined by immediate symptom resolution was 100%, similar to success rates reported elsewhere.…”

“…Procedure success as defined by immediate symptom resolution was 100%, similar to success rates reported elsewhere. 5,7,9,15 All procedures were performed on an outpatient basis, with subsequent hospitalization required in 36% of the patients. The median length of hospitalization (if necessary) was 3.5 days.…”

“…The perforation rate (27%) was slightly higher than that of earlier studies. 1,5,[7][8][9]12,14,15 Of the 6 patients in whom perforation was identified, 3 required hospitalization for 3 or fewer nights (mild severity), 2 required 4 nights (moderate severity), and only 1 required admission to the intensive care unit (severe). 16 At a mean (SD) follow-up of 12.7 (9.2) months, 68% of patients had complete or near-complete resolution of symptoms, 14% had moderate improvement of their symptoms, and 18% had complete recurrence of symptoms.…”

“…Performed by endoscopists (gastroenterologists or surgeons), it was first introduced in 1995 4 as an alternative to open surgical and rigid endoscopic techniques; however, outcome data are still relatively limited, and, except for one small series, are from studies performed outside the United States. [4][5][6][7][8][9][10][11] Preliminary data suggest that flexible endoscopic therapy may result in similar success rates, low recurrence rates, and low complication rates, with several added advantages 1 : the procedure is performed without general anesthesia and in an outpatient setting, and resumption of oral intake is more rapid. In this case series, we describe the Mayo Clinic experience with flexible endoscopic CP myotomy and several important outcome measures.…”

Transoral endoluminal approach to Zenker's diverticulum using LigasureTM: early clinical experience

“…However, treatment limitations linger on despite leading-edge techniques. Among diverticular septal section techniques using a flexible endoluminal approach the following should be highlighted: Needle-knife sphincterotome (4,5), monopolar or bipolar coagulation forceps (6,7), and argon plasma coagulation (8,9). These septal section modalities have been combined with various technical modifications to improve septum visibility and exposure, including the use of nasogastric tubes, a transparent hood at the tip of a flexible endoscope, or an ad-hoc diverticulotomy overtube (10,11).…”