Endoscopic treatment of Zenker's diverticulum

Abstract

Introduction: The Zenker’s Diverticulum (ZD) is a rare acquired condition. It is a pouch that can  form at  posterior wall of the esophagus through the Killian's triangle.Endoscopic myotomy is the endoscopic treatment of first choice. Objective: To demonstrate the experience of the endoscopic treatment of ZD in a prívate center. Materials and methods: Prospective study (July 2010-September2017). Twenty-two patients with DZ (17 men, 5 women), mean age 67.6 years(39-89 years) were included. Olympus 180 endoscopy and Olympus UCR CO2 pump were used. All procedures were performed in the operating room under general anesthesia. It was used in 19 patients with Knife knife and sphincterotome needle, HybridKnife (3) connected to VIO 200D ERBE, Endocut mode Q mode, effect 2, cut 120W, 40W coagulation. Standardized endoscopic septotomy technique was performed. Results: 22 patients with DZ diagnosis. Symptoms: dysphagia (10), cough (14), regurgitation (13), bronchoaspiration (3), halitosis (12). Mean endoscopic time 47.8(30-60) min. In 1pac, septotomy  was done in 2 sessions. Primary success evaluated for improvement of symptoms: At 12 h: 17 pac(77.3%), 24h: 3pac(13.6%), 48 h 2pac(9.1%).Radiological control (Rx) was performed at 24 h, showing Rx resolution in all patients. Complications: Bleeding 2pac (9.1%) resolved endoscopically. Mortality was not reported. Average hospital stay 47(24-96) h. Follow-up 24 months, controls every 3 months, recurrence of symptoms was not reported. Conclusions: Our results are comparable with those reported in the literature in relation to safety, efficacy and low morbidity and mortality of the endoscopic treatment of Zenker’s Diverticulum. The recurrence rate seems to be related to the longitudinal amplitude of the incision made.