Endotherapy of Zenker's diverticulum using the needle-knife technique: long-term follow-up.
OBJECTIVE
Endotherapy of Zenker's diverticulum by mucomyotomy of the bridge between the diverticulum and the esophageal lumen has been introduced as a promising alternative to surgical techniques. However the data on long-term clinical outcome are limited. After poor results in four patients treated by argon plasma coagulation, we studied the efficacy and the long-term outcome of dissection using a needle-knife in a consecutive series of patients.


METHODS
Between December 2001 and November 2004, 31 consecutively treated symptomatic patients (18 men; median age 69 years; range 52-92) with Zenker's diverticulum were enrolled into this retrospective study. In all cases mucomyotomy was performed with a needle-knife with the patient under conscious sedation. The procedure was repeated in the case of incomplete relief from dysphagia or of recurrent symptoms during follow-up. All patients completed questionnaires on the frequency and severity of dysphagia, using a numeric analogue scale, ranging from 0 (never/none/excellent) to 10 (each time of swallowing/very severe/very bad).


RESULTS
Endoscopic mucomyotomy was achieved in all 31 patients, with initial symptomatic improvement. Repeat treatment was required in 10 patients after a mean of 5.3 months, due to recurrence of symptoms. During a mean follow-up period of 26 months (range 14-49), 26 patients (84%) had long-term success of variable degree (65% with no or minimal remaining symptoms); four patients (13%) had insufficient relief and wanted a repeat treatment; and one patient (3%) underwent surgery. The success rate in the entire group was 84% (26/31) including those with repeat treatment, and 61% (19/31) if only success following a single treatment session was counted. Minor complications such as subcutaneous or mediastinal emphysema were observed in 23% and were conservatively managed. There were no major complications.


CONCLUSIONS
A single needle-knife mucomyotomy procedure can achieve long-term symptomatic improvement in about two out of three cases of Zenker's diverticulum. The success rate can be increased to above 80% by repeated sessions. Minor complications occur frequently but they can be conservatively managed. Major complications were not observed. Further long-term studies are warranted to elucidate the role of endoscopy as a definitive single treatment, with determination of prognostic parameters for a successful long-term outcome.
Vogelsang
A
A
Medizinische Klinik, Evangelisches Krankenhaus Düsseldorf, Germany. medizinischeklinik@evk-duesseldorf
Preiss
C
C
Neuhaus
H
H
Schumacher
B
B
D000368:Aged; D000369:Aged, 80 and over; D020701:Esophagoscopes; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013525:Surgical Instruments; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D016672:Zenker Diverticulum / Q000601:surgery*