Year 2016 / Volume 108 / Number 6
Original
Flexible endoscopic treatment of Zenker’s diverticulum: thirteen years’ experience in Spain

297-303

DOI: 10.17235/reed.2016.4030/2015

Emilio Jesús de la Morena Madrigal, Elena Pérez Arellano, Isabel Rodríguez García,

Abstract
Introduction: Flexible endoscopic treatment is one of the alternative approaches for the management of Zenker’s diverticum. The present paper shows our short-term and long-term results with flexible endoscopic cricopharyngeal myotomy/septotomy. Patients and methods: A retrospective analysis of our experience in patients with Zenker’s diverticulum treated using a flexible endoscope, assisted by a flexible diverticuloscope, between 2002 and 2015. Myotomy/septotomy was performed with a needle-knife papillotome under deep sedation or general anesthesia. Results: Among the 64 patients treated, two died within 10 days of surgery from causes not directly related to the procedure, and one presented with pharyngo-esophageal perforation, which recovered with conservative management at 47 days after admission. Four additional patients were lost to short-term follow-up. Among the 57 remaining patients, 52 had complete relief of dysphagia after 6 weeks. Eleven of these had recurrent symptoms on the mid and the long term. Eight were retreated with the same flexible endoscopic technique, one with a hybrid endoscopic approach, one with classical open surgery and one refused retreatment. After a mean follow-up of 2 years and a half, 33 of 37 patients reported absent or minimal dysphagia, controllable with punctual dietary restrictions. Conclusions: Flexible endoscopic treatment for Zenker’s diverticulum is effective and safe. It represents an option on an equal footing to rigid endoscopy and classical open surgery and may also be used when the latter two are technically impracticable or contraindicated.
Share Button
New comment
Comments
No comments for this article
References
1. Belsey RH. Functional disease of the esophagus. J Thoracic Cardiovasc Surg 1966;52:164-88
2. Ellis FH, Schlegel JF, Lynch VP, et al. Cricopharyngeal myotomy for pharyngo-esophageal diverticulum. Ann Surg 1969;170:340-9
3. Dohlman G, Mattson O. The endoscopic operation for hypopharingeal diverticula: a roentgen-cinematographic study. Arch Otolaryngol 1960;71:744-52
4. Collard IM, Otte IB, Kestens PJ. Endoscopic stapling technique of esophago-diverticulostomy for Zenker’s diverticulum. Ann Thorac Surg 1993;56:573-6
5. Ishioka S, Sakai P, Maluf-Filho F, et al. Endoscopic incision of Zenker’s diverticula. Endoscopy 1995;27:433-7
6. Mulder CJJ, den Hartog G, Robijn RJ, et al. Flexible endoscopic treatment of Zenker’s diverticulum: a new approach. Endoscopy 1995;27:438-42
7. Hashiba K, De Paula AL, Da Silva JGN, et al. Endoscopic treatment of Zenker’s diverticulum. Gastrointest Endosc 1999;49:93-7
8. Mulder CJJ. Zenker’s diverticulum: treatment with a flexible endoscope. Gastrointest Endosc 1999;50:596-7
9. Dzeletovic I, Ekbom DC, Baron TH. Flexible endoscopic and surgical management of Zenker’s diverticulum. Expert Rev Gastroenterol Hepatol 2012;6:449-66
10. Dakkak M, Bennett JR. A new dysphagia score with objective validation. J Clin Gastroenterol 1992;14:99-100
11. De la Morena E, Pérez-Arellano E, Carreño R, et al. Tratamiento endoscópico del divertículo de Zenker. Cir Esp 2005;78:256-9
12. Sharma R, DeCroos AJ. Zenker’s diverticulitis secondary to alendronate ingestion: a rare cause of recurrent dysphagia. Gastrointest Endosc 2011;73:368-70
13. Tang SJ, Jazrawi SF, Chen E, et al. Flexible endoscopic clip-assisted Zenker’s diverticulotomy: the first case series. Laryngoscope 2008;118:1199-205
14. Case DJ, Baron TH. Flexible endoscopic management of Zenker diverticulum: the Mayo Clinic experience. Mayo Clin Proc 2010;85:719-22
15. Evrard S, Le Moine O, Hassid S, et al. Zenker’s diverticulum: a new endoscopic treatment with a soft diverticuloscope. Gastrointest Endosc 2003;58:116-20
16. Costamagna G, Iacopini F, Tringali A, et al. Flexible endoscopic Zenker’s diverticulotomy: cap-assisted technique vs. diverticuloscope-assisted technique. Endoscopy 2007;39:146-52
17. Sakai P, Ishioka S, Maluf-Filho F, et al. Endoscopic treatment of Zenker’s diverticulum with an oblique-end hood attached to the endoscope. Gastrointest Endosc 2001;54:760-3
18. Costamagna G, Mutignani M, Tringali A, et al. Treatment of Zenker’s diverticulum with the help of a plastic hood attached to the endoscope. Gastrointest Endosc 2002;56:611-2
19. Christiaens P, De Roock W, Van Olmen A, et al. Treatment of Zenker’s diverticulum through a flexible endoscope with a transparent oblique-end hood attached to the tip and monopolar forceps. Endoscopy 2007;39:137-40
20. Rabenstein T, May A, Michel J, et al. Argon plasma coagulation for flexible endoscopic Zenker’s diverticulotomy. Endoscopy 2007;39:141-5
21. Vogelsang A, Preiss C, Neuhaus H, et al. Endotherapy of Zenker’s diverticulum using the needle-knife technique: long term follow-up. Endoscopy 2007;39:131-6
22. Mulder CJJ, Costamagna G, Sakai P. Zenker’s diverticulum: Treatment using a flexible endoscope. Endoscopy 2001;33:991-7
23. Huberty V, El Bacha S, Blero D, et al. Endoscopic treatment for Zenker’s diverticulum: long-term results. Gastrointest Endosc 2013;77:701-7
24. Repici A, Pagano N, Romeo F, et al. Endoscopic flexible treatment of Zenker’s diverticulum: a modification of the needle-knife technique. Endoscopy 2010;42:532-5
25. Manno M, Manta R, Caruso A, et al. Alternative endoscopic treatment of Zenker’s diverticulum: a case series. Gastrointest Endosc 2014;79:168-70
26. Curcio G, Granata A, Bertani A, et al. Insulated-tip dissecting knife to treat Zenker’s diverticulum: Is insulation the key? Gastrointest Endosc 2014;80:537-8
27. Ramchandani M, Reddy N. New endoscopic “scissors” to treat Zenker’s diverticulum. Gastrointest Endosc 2013;78:645-8
28. Iacopini F, Costamagna G, Scozzaro A. Scissor-shaped diatermic knife with diverticuloscope assistance for Zenker’s diverticulum septotomy. Gastrointest Endosc 2014;79:540-2
29. Hondo FY, Maluf-Filho F, Giordano-Nappi JH, et al. Endoscopic treatment of Zenker’s diverticulum by harmonic scalpel. Gastrointest Endosc 2001;74:666-71
30. Noguera J, Dolz C, Vilella A, et al. Transoral endoluminal approach to Zenker’s diverticulum using Ligasure™. Early clinical experiencie. Rev Esp Enferm Dig 2014;106:137-41
Citation tools
de la Morena Madrigal E, Pérez Arellano E, Rodríguez García I. Flexible endoscopic treatment of Zenker’s diverticulum: thirteen years’ experience in Spain . 4030/2015


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 412 visits.
This article has been downloaded 224 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 02/10/2015

Accepted: 14/02/2016

Online First: 08/04/2016

Published: 03/06/2016

Article revision time: 126 days

Article Online First time: 189 days

Article editing time: 245 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology