Endoscopic incision of Zenker's diverticula.
OBJECTIVE
The endoscopic treatment of symptomatic pharyngoesophageal diverticula (PED) with rigid instruments involves the incision of the septum between the diverticulum and the esophageal lumen, within which the cricopharyngeal muscle is present. The aim of this study is to report on the feasibility and efficacy of our method using flexible endoscopy and an electro-surgery system with minimal trauma to the patients.


METHODS
Forty-two patients (13 female, 29 male) with symptomatic pharyngoesophageal diverticula underwent endoscopic treatment. The average age of the patients was 68.4 years (range 46 to 102 years) and 26 of them (61%) had concomitant cardiopulmonary diseases. The procedure consisted of endoscopic incision of the septum with a needle knife, using cutting/coagulation current. It was performed under preparation for routine endoscopic examination. All patients were clinically and endoscopically evaluated at two and four weeks, and afterwards followed clinically at 12, 24, and 60 months after the procedure.


RESULTS
The endoscopic incision was performed in one to live sessions (mean of 1.8 session per patient). Two complications (one cervical emphysema, and one hemorrhage) were managed clinically. Dysphagia disappeared in all patients soon after the treatment, although the post-operative radiological and endoscopic controls revealed the presence of a remaining diverticulum. Manometric findings disclosed a significant reduction in upper esophageal sphincter pressures in all five patients after endoscopic incision. Mean follow-up was 38 months. There was recurrence of dysphagia in three patients (7.1%) at 12, 22, and 60 months after the procedure. They experienced relief of dysphagia after a repeated endoscopic incision.


CONCLUSIONS
Endoscopic incision of PED using flexible equipment proved to be a highly efficient and safe method of treating symptomatic disease. It should be considered as an alternative therapy for Zenker's diverticula, especially for patients at a high surgical risk.
Department of Gastrointestinal Endoscopy, São Paulo Medical School, Brazil.
S
S
Ishioka
P
P
Sakai
F
F
Maluf Filho
J M
JM
Melo
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004564:Electrocoagulation / Q000295:instrumentation*; D019723:Endoscopes; D020701:Esophagoscopes; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D016896:Treatment Outcome; D016672:Zenker Diverticulum / Q000473:pathology / Q000601:surgery*