Endoscopic Diverticulotomy for the Treatment of Zenker's Diverticulum: Results in 102 Patients with Staple-Assisted Endoscopy

• Published in: Annals of otology, rhinology & laryngology Vol. 108; no. 8; pp. 810 - 815
• Main Authors: Narne, Surendra, Cutrone, Cesare, Chella, Barbara, Bonavina, Luigi, Peracchia, Alberto
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.08.1999; Annals Publishing Compagny; SAGE PUBLICATIONS, INC
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Diverticulitis - surgery; Endoscopes; Endoscopy - methods; Esophagus; Female; Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics; Humans; Male; Medical sciences; Middle Aged; Postoperative Period; Reoperation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Surgery of the upper aerodigestive tract; Sutures; Treatment Outcome; Zenker Diverticulum - surgery; endoscopic diverticulotomy; Zenker's diverticulum; pharyngoesophageal diverticulum; Human; Endoscopic surgery; Diverticulectomy; Esophageal disease; Result; Treatment; Surgery; Digestive diseases; ENT disease; Staple(surgery); Diverticulum; Pharynx disease; Technique; Pharyngoesophageal
• ISSN: 0003-4894; 1943-572X
• DOI: 10.1177/000348949910800817

Endoscopic diverticulotomy for the treatment of Zenker's diverticulum has been reported infrequently in the literature and has engendered considerable controversy. Between March 1992 and September 1996, we attempted to treat 102 patients with endoscopic treatment for pharyngoesophageal diverticula. In 98 patients, the endoscopic surgery was successfully completed. Conversion to open surgery was required in 4 patients (3.92%). One cartridge of staples in 16 patients (16.32%), 2 cartridges in 78 patients (79.59%), and 3 cartridges in 4 patients (4.08%) were used, according to the size of the diverticulum; the median duration of the procedure was 20 minutes (10 to 60 minutes). No postoperative morbidity or mortality was recorded. Oral feeding was started following radiologic control after a median of 2 days; the median hospital stay was 4 days. The median follow-up is 16 months (1 to 45 months). Four patients operated on before the introduction of the modified stapler showed a persistent diverticular pouch: 3 underwent repeat endoscopic operation, and 1 underwent conventional open surgery. All treated patients are asymptomatic. Manometric study performed in 15 patients showed a significant reduction of basal upper esophageal sphincter pressure compared to preoperative data (48.30 ± 21.74 versus 29.38 ± 5.68 mm Hg; p < .01). We therefore recommend endoscopic diverticulotomy, considering that the procedure is relatively safe and effective, with minimal patient discomfort, and the results are equal to those of the external approach. This procedure offers the advantages of short hospitalization, rapid convalescence, brief operative time, absence of skin incision, predictable resolution of symptoms, and reduced morbidity.