Endoscopic treatment of Zenker diverticulum: results of a 7-year experience.
BACKGROUND
Zenker diverticulum (ZD) is a rare disease usually seen in elderly patients who present with symptoms of worsening dysphagia and regurgitation. Although open surgical approach is still the standard management for symptomatic patients, the endoscopic technique has evolved as an alternative approach, especially for highly morbid patients. We are reporting our experience for treating ZD using endoscopic needle-knife papillotome.


METHODS
A total of 18 patients with a mean age of 80 years (range 68 to 91 years) were included in our prospective cohort study. All patients underwent endoscopic cricopharyngeal myotomy for symptomatic ZD using needle-knife papillotome at Brandon Regional Health Centre during a 7-year period. Mean follow-up was 27.5 months. A dysphagia score system from 0 (no dysphagia) to 4 (severe dysphagia) was used. All patients' baseline characteristics, pre- and postoperative symptoms, operative time, time to oral intake, length of hospital stay, recurrence of symptoms, and complications were analyzed.


RESULTS
Dysphagia score and regurgitation symptoms improved substantially after treatment. Mean operative time was 28.4 minutes. Oral intake was resumed within 24 hours in all but 1 patient. Hospital stay for the majority was 24 to 48 hours. Only 1 patient had a microperforation treated conservatively and 2 patients had re-do procedures for persistence of dysphagia.


CONCLUSIONS
Endoscopic cricopharyngeal myotomy using needle-knife papillotome is an effective approach to manage ZD for highly morbid patients. It is minimally invasive, decreases anesthetic time, shortens hospital stay, and has a low complication rate.
Al-Kadi
Azzam S
AS
Department of Upper GI and Laparoscopic Surgery, Peter-Lougheed Center, Calgary, Alberta, Canada.
Maghrabi
Ashraf A
AA
Thomson
Denise
D
Gillman
Lawrence M
LM
Dhalla
Sonny
S
D000368:Aged; D000369:Aged, 80 and over; D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057045:Laryngopharyngeal Reflux / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D007902:Length of Stay; D008297:Male; D010609:Pharyngeal Muscles / Q000601:surgery; D011446:Prospective Studies; D012008:Recurrence; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D016672:Zenker Diverticulum / Q000150:complications / Q000175:diagnosis / Q000601:surgery*