Flexible Endoscopic Management of Zenker Diverticulum: The Mayo Clinic Experience

OBJECTIVE To describe the outcome of patients undergoing flexible endoscopic therapy for symptomatic Zenker diverticulum. PATIENTS AND METHODS We retrospectively evaluated the outcome of 22 consecutive patients who underwent flexible endoscopic cricopharyngeal myotomy using needle-knife electrocaute...

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Published inMayo Clinic proceedings Vol. 85; no. 8; pp. 719 - 722
Main Authors Case, David J., MD, Baron, Todd H., MD, FASGE
Format Journal Article
LanguageEnglish
Published England Elsevier Inc 01.08.2010
Elsevier, Inc
Elsevier Limited
Mayo Foundation for Medical Education and Research
Subjects
Aged
Aged, 80 and over
Ambulatory Surgical Procedures
Care and treatment
Diagnosis
Diverticulum
Electrocoagulation
Endoscopy
Endoscopy, Digestive System
Female
Health aspects
Humans
Internal Medicine
Male
Middle Aged
Original
Pharyngeal Muscles - surgery
Retrospective Studies
Treatment Outcome
Zenker Diverticulum - surgery
United States
NG
nasogastric
cricopharyngeal
CP
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Summary:OBJECTIVE To describe the outcome of patients undergoing flexible endoscopic therapy for symptomatic Zenker diverticulum. PATIENTS AND METHODS We retrospectively evaluated the outcome of 22 consecutive patients who underwent flexible endoscopic cricopharyngeal myotomy using needle-knife electrocautery performed by a single endoscopist from March 2006 through January 2010. RESULTS Of the 22 patients with symptomatic Zenker diverticulum, 13 were men and 9 were women (median age, 84.5 years). Moderate sedation was used in all but 3 (14%) of the patients. Postprocedural free air occurred in 6 patients (27%) and resolved uneventfully in all. Another patient developed a neck abscess 1 week after endoscopic treatment, which was surgically drained. All procedures were performed on an outpatient basis, although 8 patients (36%) required subsequent hospitalization. The mean (SD) length of stay in the hospital was 2.9 (1.64) days. All patients had initial symptomatic improvement, and 18 (82%) maintained improvement at a mean (SD) follow-up of 12.7 (9.2) months. CONCLUSION Flexible endoscopic cricopharyngeal myotomy is an effective treatment of symptomatic Zenker diverticulum, with low recurrence rates and with the benefit of no general anesthesia and hospitalization in most cases. Esophageal perforation is the most common procedural complication.
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ISSN:0025-6196
1942-5546
DOI:10.4065/mcp.2009.0663