title: Argon plasma coagulation for flexible endoscopic Zenker's diverticulotomy.
abstract: OBJECTIVE
  The increasing use of flexible endoscopy to treat symptomatic Zenker's diverticulum is only partially supported by data on safety and benefits. This retrospective study reports the mid-term results of argon plasma coagulation (APC) for flexible endoscopic therapy of Zenker's diverticulum.
  
  
  METHODS
  Between January 2002 and July 2006, 41 patients (27 men, 14 women, mean age +/- standard deviation [SD] 73 +/- 11 years) were treated by means of APC flexible endoscopic Zenker's diverticulotomy. Technical and immediate clinical success (on a 3-month control examination) was assessed for the entire group. Mid-term follow-up data were obtained for patients treated until December 2005 (n = 34) with a mean +/- SD follow-up period of 16 +/- 5 months.
  
  
  RESULTS
  Technical success was achieved in all 41 patients, with a mean +/- SD of 3 +/- 2 treatment sessions during one or two hospitalizations (1-3 sessions for 78% patients, > 3 sessions for 22% patients). Immediate clinical success was achieved in 95% of cases. Fever occurred in seven patients (17%), lasting less than 24 hours in three patients (7%) and associated with clinical infections in four (10%); one perforation occurred, which was managed conservatively. In the patients for whom we had mid-term follow-up data, 5/34 experienced recurrence and achieved a successful clinical outcome after retreatment with APC.
  
  
  CONCLUSIONS
  APC treatment of Zenker's diverticulum is safe and effective in the short term, with a mean of three treatment sessions. Recurrence rates of around 15% have to be expected on mid-term follow-up. The relative value of APC vs. needle-knife techniques can only be clarified in a prospective randomized study.
authors.affiliation: Department of Medicine II, Dr.-Horst-Schmidt-Kliniken Wiesbaden, Wiesbaden, Germany. thomas.rabenstein@hsk-wiesbaden.de
authors.forename: T
authors.initials: T
authors.lastname: Rabenstein
authors.forename: A
authors.initials: A
authors.lastname: May
authors.forename: J
authors.initials: J
authors.lastname: Michel
authors.forename: H
authors.initials: H
authors.lastname: Manner
authors.forename: O
authors.initials: O
authors.lastname: Pech
authors.forename: L
authors.initials: L
authors.lastname: Gossner
authors.forename: C
authors.initials: C
authors.lastname: Ell
mesh_terms: D000368:Aged; D001128:Argon; D004564:Electrocoagulation / Q000379:methods*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D016672:Zenker Diverticulum / Q000601:surgery*
chemical_list: D001128:Argon