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

• Published in: Gastrointestinal endoscopy 2013-05, Vol.77 (5), p.701-707
• Main Authors: Huberty, Vincent, MD, El Bacha, Souraya, MD, Blero, Daniel, MD, PhD, Le Moine, Olivier, MD, PhD, Hassid, Sergio, MD, PhD, Devière, Jacques, MD, PhD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Cough - etiology; Deglutition Disorders - etiology; Endoscopy, Gastrointestinal - adverse effects; Endoscopy, Gastrointestinal - instrumentation; Endoscopy, Gastrointestinal - methods; Female; Follow-Up Studies; Gastroenterology and Hepatology; Humans; Laryngopharyngeal Reflux - etiology; Male; Middle Aged; Recurrence; Retrospective Studies; Severity of Illness Index; Time Factors; Treatment Outcome; Zenker Diverticulum - complications; Zenker Diverticulum - surgery
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2012.12.008

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.