Endoscopic treatment for Zenker's diverticulum: long-term results (with video)

Abstract

Background: Diverticulotomy is a standard treatment for Zenker's diverticulum (ZD). This technique was adapted to flexible endoscopy.

Objective: We report our long-term results of ZD treatment by using flexible endoscopy assisted by a soft diverticuloscope.

Design: Follow-up study.

Setting: Academic hospital. Tertiary-care referral center.

Patients: A total of 150 patients with ZD were treated with the same technique from July 2002 to June 2011.

Intervention: The procedure was performed by using a soft diverticuloscope to expose the septum, which was then cut with a needle-knife, and the procedure was completed by use of endoclip placement at the bottom of the section.

Main outcome measurements: Symptoms were compared before and after the procedure, 1 month later, and at the end of follow-up.

Results: The median size of the ZD was 3 cm (range 1-8 cm). The endoscopic incision was performed in one session (range 1-3 sessions). Clinical success at 1 month was 90.3%. Four adverse events (2.2%) occurred and were managed conservatively. Symptom evaluation at 1 month and at the end of follow-up was obtained in 103 and 134 patients, respectively. The dysphagia score dropped from 1.88 to 0.29 (P < .01) and 0.34 (P < .05) at 1 month and at the end of follow-up, respectively (median 43 months, range 13-121 months). Regurgitations and chronic cough dropped from 73% and 27% to 11% and 2% at the end of follow-up, respectively. Symptom recurrence occurred in 31 patients (23.1%); among them 23 had a second treatment, and only 5 required a third one.

Limitations: Retrospective study, single center.

Conclusion: Endoscopic incision of ZD by using a soft diverticuloscope and completed by endoclips is safe and efficient at short term and long term.