Zenker’s diverticulum: endoscopic treatment with or without diverticulotome
DOI:
https://doi.org/10.22516/25007440.504Keywords:
Dysphagia, Zenker, endoscopic diverticulotomy, diverticulotome, complicationsAbstract
Zenker’s diverticulum is defined as a diverticulum located in the posterior esophageal wall, just above the
cricopharyngeal muscle. Most patients experience symptoms in this area after the age of 60. In the past, the standard treatment was surgical diverticulotomy, but endoscopic treatment was introduced over 20 years ago. For more than 15 years, overtubes are introduced to facilitate the procedure, but their use is not been widely established in our country. Therefore, this study aims to evaluate whether endoscopic diverticulotomy with the use of this device is easier (faster) than the standard method.
Materials and methods: A prospective study was conducted to establish which of the two endoscopic methods to treat Zenker’s diverticulum (ZD) made the septum incision time shorter. The time count was done using video recording and started when the probe —standard method (SM)— or the overtube (MD) were placed, as this is the exact moment when septum cutting begins. The count stopped when the cut was finalized.
Results: A total of 20 patients were treated from January 2015 to December 2018. Zenker’s diverticulum diagnosis was achieved by endoscopy and esophagogram to classify the size of the tumor. The average age of the patients was 61 years (46-85). Ten patients were assigned to each group. Symptoms resolved in 7 patients of the SM group, compared to 9 in the MD group. The three patients who did not respond to the treatment were classified as stage II in the functional outcome swallowing scale at 18 months of follow-up. The average time of the procedure was 32 (25-45) minutes in the SM group and 12 (7-15) minutes in the MD group (p <0.001).
Conclusions: ZD myotomy with flexible endoscopy using an overtube has potential benefits in terms of shorter operative times, shorter post-operative stays, and an earlier reintroduction of food. From a technical point of view, this method allows for better exposure of the septum, which facilitates cutting. However, more extensive studies are needed to confirm these results.
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