Zenker diverticulum treatment: retrospective comparison of flexible endoscopic window technique and surgical approaches

Calavas, Laura; Brenet, Esteban; Rivory, Jérôme; Guillaud, Olivier; Saurin, Jean‐Christophe; Céruse, Philippe; Ponchon, Thierry; Pioche, Mathieu

doi:10.1007/s00464-020-07865-1

Cited by 11 publications

(7 citation statements)

References 28 publications

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“…Leong et al demonstrated a 12.8 % recurrence rate after rigid stapled endoscopic septotomy in a meta-analysis including 585 patients; our study reported a lower recurrence rate of 9.1 % 26 . A recent retrospective study demonstrated fewer residual symptoms and better postoperative quality of life following flexible endoscopic septotomy when compared with rigid endoscopic septotomy 27 .…”

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confidence: 99%

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

et al. 2021

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Background Treatment of Zenker’s diverticulum has evolved from open surgery to endoscopic techniques, including flexible and rigid endoscopic septotomy, and more recently, peroral endoscopic myotomy (Z-POEM). This study compared the effectiveness of flexible and rigid endoscopic septotomy with that of Z-POEM. Methods Consecutive patients who underwent endoscopic septotomy (flexible/rigid) or Z-POEM for Zenker’s diverticulum between 1/2016 and 9/2019 were included. Primary outcomes were clinical success (decrease in Dakkak and Bennett dysphagia score to ≤ 1), clinical failure, and clinical recurrence. Secondary outcomes included technical success and rate/severity of adverse events. Results 245 patients (110 females, mean age 72.63 years, standard deviation [SD] 12.37 years) from 12 centers were included. Z-POEM was the most common management modality (n = 119), followed by flexible (n = 86) and rigid (n = 40) endoscopic septotomy. Clinical success was 92.7 % for Z-POEM, 89.2 % for rigid septotomy, and 86.7 % for flexible septotomy (P = 0.26). Symptoms recurred in 24 patients (15 Z-POEM during a mean follow-up of 282.04 [SD 300.48] days, 6 flexible, 3 rigid [P = 0.47]). Adverse events occurred in 30.0 % rigid septotomy patients, 16.8 % Z-POEM patients, and 2.3 % flexible septotomy patients (P < 0.05). Conclusions There was no difference in outcomes between the three treatment approaches for symptomatic Zenker’s diverticulum. Rigid endoscopic septotomy was associated with the highest rate of complications, while flexible endoscopic septotomy appeared to be the safest. Recurrence following Z-POEM was similar to flexible and rigid endoscopic septotomy. Prospective studies with long-term follow-up are required.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…In this retrospecƟve cohort study the number and severity of postoperaƟve complicaƟons in pretreated paƟents is significantly than in those undergoing primary surgey for Zneker´s diverƟculum Extended author information available on the last page of the article Zenker's diverticulum is a disease of the aged population and in recent times preferentially treated by an endoscopic approach. In comparison to the conventional, open technique, the endoscopic therapy is proven to be advantageous in terms of shorter hospitalization, reduced morbidity and an almost zero mortality rate [1][2][3]. Zenker's diverticulum is a rare disease which is affecting only 2 out of 100.000 patients, and only few studies regarding outcomes of endoscopic and open surgical treatments were published in recent years [4][5][6].…”

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confidence: 99%

“…Here, the authors describe the efficacy and safety of the endoscopic method. Due to the good and low complication feasibility of endoscopic therapy, patients often undergo multiple endoscopic therapies in case of recurrence [2,3,7]. Thus, most of the patients being referred for open surgical repair, have had previous endoscopic treatments in an increasing percentage.…”

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The impact of prior endoscopic or surgical therapy on open Zenker’s diverticulum surgery: analysis on a large single center cohort

et al. 2022

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Background Endoscopic treatment of Zenker’s diverticulum is an attractive minimally invasive alternative compared to the classic open approach. However, increased recurrence rate were reported. In case of relapse, endoscopic therapy might be repeated, or alternatively open surgery is performed. This study aimed to identify potential differences in the outcomes between primary or secondary surgical treatment in Zenker’s diverticulum. Methods From January 2003 to April 2019, 227 subsequent patients underwent surgical diverticulectomy and cervical myotomy at the surgical department of TUM. 41 of 227 patients had received previous therapy, either open or endoscopic. Perioperative parameters in priorly untreated patients were retrospectively compared to those after previous therapy (mostly endoscopic) with special regard to perioperative data and postoperative complications. Univariate and multivariate regression analyses were performed to identify predictors for postoperative complications. Results We could show that the number of complications (p = 0.047) in pretreated patients is significant higher as well as the severity after Clavien–Dindo (p = 0.025). Stapler line leakage, wound infections, and operative revision rate was higher also pretreated group. Pretreatment and surgery time showed a significant association with postoperative complications in univariate analysis. In multivariate analysis, pretreatment remained a significant independent predictor of complications. Conclusion The present data indicate that endoscopic therapy might represent a risk factor for postoperative complications in case of relapse surgery. Therefore primary open surgery should be debated in patients with an increased high risk of relapse. Graphical abstract

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“…Zenker's diverticulum is a pulsion diverticulum developed in an area of weakness known as the Killian's triangle. Flexible endoscopic treatment of this condition was first introduced in 1982 and is now the first line of treatment [1]. This technique involves the division of the septum of the diverticulum, by incision with a cutting device, in order to achieve the cricopharyngeal myotomy, with the ob-jective to reduce the size of the diverticulum and improve the symptoms (dysphagia, regurgitation, and respiratory symptoms).…”

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Zenkerʼs diverticulum peroral endoscopic myotomy is effective in the case of an incipient Zenkerʼs diverticulum

et al. 2022

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Zenker diverticulum treatment: retrospective comparison of flexible endoscopic window technique and surgical approaches

Cited by 11 publications

References 28 publications

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

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

The impact of prior endoscopic or surgical therapy on open Zenker’s diverticulum surgery: analysis on a large single center cohort

Zenkerʼs diverticulum peroral endoscopic myotomy is effective in the case of an incipient Zenkerʼs diverticulum

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