Flexible endoscopic management of Zenker diverticulum: the Mayo Clinic experience.
OBJECTIVE
To describe the outcome of patients undergoing flexible endoscopic therapy for symptomatic Zenker diverticulum.


METHODS
We retrospectively evaluated the outcome of 22 consecutive patients who underwent flexible endoscopic cricopharyngeal myotomy using needle-knife electrocautery performed by a single endoscopist from March 2006 through January 2010.


RESULTS
Of the 22 patients with symptomatic Zenker diverticulum, 13 were men and 9 were women (median age, 84.5 years). Moderate sedation was used in all but 3 (14%) of the patients. Postprocedural free air occurred in 6 patients (27%) and resolved uneventfully in all. Another patient developed a neck abscess 1 week after endoscopic treatment, which was surgically drained. All procedures were performed on an outpatient basis, although 8 patients (36%) required subsequent hospitalization. The mean (SD) length of stay in the hospital was 2.9 (1.64) days. All patients had initial symptomatic improvement, and 18 (82%) maintained improvement at a mean (SD) follow-up of 12.7 (9.2) months.


CONCLUSIONS
Flexible endoscopic cricopharyngeal myotomy is an effective treatment of symptomatic Zenker diverticulum, with low recurrence rates and with the benefit of no general anesthesia and hospitalization in most cases. Esophageal perforation is the most common procedural complication.
Case
David J
DJ
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA. baron.todd@mayo.edu
Baron
Todd H
TH
D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures; D004564:Electrocoagulation; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010609:Pharyngeal Muscles / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D016672:Zenker Diverticulum / Q000601:surgery*