Zenker Diverticulum Treatment: Endoscopic or Surgical?

Abstract

RezumatIntroducere: Diverticulul Zenker constituie o patologie rară, selecţia pacienţilor pentru tratamente invazive este discutabilă, precum şi metoda terapeutică aplicată. Scopul studiului este de a evalua principalele metode de tratament-chirurgical clasic si endoscopic, în această patologie şi de a corela aspectele fiziopatologice cu consecinţele clinice. Material şi metodă: Am inclus în lotul de studiu 36 pacienţi cu diverticuli cervicali Zenker trataţi în perioada 2010/2017 în două clinici universitare: 7 pacienţi prin abord chirurgical clasic la Clinica de Chirurgie Generală şi Esofagiană a Spitalului Clinic Sfânta Maria Bucureşti şi 29 de pacienţi cu abord endoscopic la Departamentul de Endoscopie Digestivă de Diagnostic şi Intervenţională din cadrul Institutului Regional de Hepatologie şi Gastroenterologie Prof. Dr. Octavian Fodor, Cluj-Napoca. Vârsta pacienţilor a fost cuprinsă între 42 şi 84 ani şi în decada a 7a -15 pacienţi. Rezultate: Miotomia cricofaringiană s-a efectuat la toţi pacienţii. Diverticulectomia s-a practicat la 7 pacienţi, cei trataţi chirurgical. Durata de spitalizare medie a fost de 4 zile. Complicaţii intraprocedurale au prezentat 3 pacienţi trataţi endoscopic şi au constat în apariţia hemoragiei laminare. La 2 pacienţi s-a practicat hemostază endoscopică cu clipuri şi pensă caldă iar la un pacient s-a efectuat hemostază endoscopică cu clipuri. Complicaţiile postprocedurale au fost: dureri locale, leucocitoză, melenă, febră,

Mujer de 91 años con obstrucción esofágica por divertículo de Zenker

“…[6][7][8][9][10][11] Other common complaints include regurgitation, halitosis, weight loss, postprandial vomitus, dysphonia, neck mass, postprandial cough, odynophagia, sialorrhea, heartburn and neck pain. [1][2][3][4][5][6][8][9][10][11][12] Complications of ZD include perforation of the diverticulum, esophageal obstruction by external compression, and recurrent bronchial aspiration followed by pneumonia. [1][2][3][4][5][6][8][9][10][11] This aspiration pneumonia is frequently due to anaerobic or mixed flora and may incidentally herald the diagnostic hypothesis of an anatomical esophageal disorder; worthy of note, the bronchial aspiration may occur without regurgitation symptoms.…”

“…1,[4][5][6]8,9 Barium esophagography establishes the diagnosis of ZD and is another useful tool for clinical investigation of ZD, in special if combined with continuous dynamic fluoroscopy during swallowing. 1,2,[4][5][6][9][10][11] UGE with biopsy is indicated in some patients for additional investigation of possible comorbidities and the exclusion of malignancy; however, there is a risk of perforation. 3,6,[9][10][11] Esophageal manometry is not mandatory, but it could contribute to clarify the pathogenesis of this kind of diverticulum.…”

“…1,2 Zenker's diverticulum (ZD), also called cricopharyngeal, pharyngoesophageal, or hypopharyngeal diverticulum, is a pouch containing only the mucosa and submucosa layers (false diverticulum) at the pharyngoesophageal junction. [1][2][3][4][5][6][7][8][9][10][11][12] This pulsion diverticulum occurs dorsally in the pharyngoesophageal wall, between the inferior constrictor muscle of the pharynx and the cricopharyngeal muscle, an area of relative weakness known as the Killian triangle or Killian dehiscence. [1][2][3][4][5][6][7][8][9][10][11][12] The annual incidence .of symptomatic ZD in the United Kingdom was estimated at two cases per 100,000 population, mainly in males, from middle age to the 9th decade of life.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12] This pulsion diverticulum occurs dorsally in the pharyngoesophageal wall, between the inferior constrictor muscle of the pharynx and the cricopharyngeal muscle, an area of relative weakness known as the Killian triangle or Killian dehiscence. [1][2][3][4][5][6][7][8][9][10][11][12] The annual incidence .of symptomatic ZD in the United Kingdom was estimated at two cases per 100,000 population, mainly in males, from middle age to the 9th decade of life. 1,2,[7][8][9][10][11] This condition was described by the first time by Ludlow in 1767, and in 1877 Zenker reported the association of this diverticulum with the upper esophageal sphincter dysfunction.…”

“…1,7,10 Currently, the therapeutic options vary between conservative and surgical treatment, which may be either classic or endoscopic. 1,[3][4][5][6][7][8][9][10][11][12] The intervention should be reserved for symptomatic patients with or without complications and the modality to be established will be defined with base on the variables previously mentioned. 1,[3][4][5][6][7][8][9][10][11][12] The aim of this report is to emphasize possible diagnostic challenges involving the Zenker's diverticulum, and to highlight the option of intervention by endoscopic approach under conscious sedation to improve the quality of life of frail elderly people.…”