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ORIGINAL PAPER

Flexible Endoscopic Treatment for Zenker’s Diverticulum – Experience on 31 Patients

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Anamaria Pop1,2, Alina Tantau2,3,4, Cristian Tefas1,3, Andrei Groza1, Marcel Tantau1,2,3

1) Prof. Octavian Fodor Regional Institute of Gastroenterology and Hepatology ;
2) Gastroenterology and Hepatology Medical Center;
3) Iuliu Hatieganu University of Medicine and Pharmacy,
4) Department of Internal Medicine, 4th Medical Clinic, Cluj-Napoca, Romania

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.273.zen

ABSTRACT
Background & Aims: The aim of this study is to present the experience of our center over the last 8 years in a series of patients with Zenker’s diverticulum (ZD), treated using an endoscopic, minimally invasive procedure.

Methods: We retrospectively included 31 patients with a previously established diagnosis of ZD based on endoscopic and oral contrast examinations. Patients’ age, comorbidities, size of the diverticulum or previous endoscopic treatment were not considered exclusion criteria. A soft, flexible diverticuloscope to expose the septum and a dual knife for “cutting” the diverticular septum were used. We analyzed the short term efficacy based on symptomatic relief and occurrence of side effects, and long term efficiency at 6 and 12 months by clinical assessment, upper gastrointestinal endoscopy and oral contrast media passage.

Results: Patients had a mean age of 67 years (range 42-86); 55% of them were male. All patients reported symptom relief after the procedure. A decrease of more than 70% from the initial size of the diverticulum was noted. There were 3 cases (9.67%) of intraprocedural hemorrhage, endoscopically managed. No serious post-procedural complications and no mortality were reported. The mean procedural time was 21.87 minutes (range 15-25 minutes). Average hospitalization was 2.5 days. Five patients developed recurrence and needed a second session of endoscopic treatment for achieving complete myotomy.

Conclusions: Endoscopic management for ZD was efficient and safe in our series of patients. A short hospitalization period was required.

Key words: esophageal diverticulum − Zenker − diverticulotomy − endoscopic treatment.

Abbreviations: ZD: Zenker diverticulum; Z-POEM: Zenker’s per oral endoscopic myotomy.