Prognostic variables for the clinical success of flexible endoscopic septotomy of Zenker's diverticulum.
OBJECTIVE
Flexible endoscopy septotomy for Zenker's diverticulum (ZD) is an alternative to endostapling; however, long-term data are sparse and studies are heterogeneous. The aim of this study was to assess the clinical success of flexible endoscopy diverticuloscope-assisted septotomy according to all ZD-related symptoms and to identify potential prognostic variables.


METHODS
A prospective database of all patients with ZD undergoing septotomy and followed up for 24 months or longer was analyzed. Septotomy was conducted by using a diverticuloscope-assisted technique. Dysphagia, regurgitation, and respiratory symptoms (during the day and at night) were scored by their weekly frequency from 0 to 3 when on a solid food diet. Clinical success (asymptomatic state) was defined as a maximum of 2 symptoms with a score of 1 (once per week). Prognostic variables of clinical success included age, sex, pretreatment total symptom score, pre- and posttreatment ZD size, and septotomy length. The Kaplan-Meier method and Cox proportional hazards model were used to calculate the crude and adjusted hazard ratio (HR).


RESULTS
Septotomy was attempted and achieved in a single session in 89 patients. Clinical success at the intention-to-treat analysis was 69%, 64%, and 46% at 6, 24, and 48 months, respectively. Adverse events occurred in 3 patients: perforation in 2 (2%) and postprocedural bleeding in 1 (1%). Independent variables for failure at 6 months were a septotomy length ≤25 mm (HR 6.34) and pretreatment ZD size ≥50 mm (HR 11.08), whereas at 48 months, they were septotomy length ≤25 (HR 2.20) and posttreatment ZD size ≥10 mm (HR 2.03). Success rates for ZD ranging in size from 30 mm to 49 mm with a septotomy >25 mm were 100% and 71% at 6 months and 48 months, respectively.


CONCLUSIONS
Flexible endoscopic septotomy for ZD is feasible and safe. Treatment success correlates with the length of the septotomy and the size of ZD, which should ultimately determine the appropriate approach.
Surgical Digestive Endoscopy, Policlinico Gemelli, Università Cattolica, Rome, Italy.
Guido
G
Costamagna
Gastroenterology and Digestive Endoscopy, Ospedale San Giuseppe, Albano L., Rome, Italy.
Federico
F
Iacopini
Surgical Digestive Endoscopy, Policlinico Gemelli, Università Cattolica, Rome, Italy; Fondazione Poliambulanza, Istituto Ospedaliero, Brescia, Italy.
Alessandra
A
Bizzotto
Surgical Digestive Endoscopy, Policlinico Gemelli, Università Cattolica, Rome, Italy.
Pietro
P
Familiari
Surgical Digestive Endoscopy, Policlinico Gemelli, Università Cattolica, Rome, Italy.
Andrea
A
Tringali
Surgical Digestive Endoscopy, Policlinico Gemelli, Università Cattolica, Rome, Italy.
Vincenzo
V
Perri
National Center for Epidemiology, Surveillance, and Health Promotion, Istituto Superiore di Sanità, Rome, Italy.
Antonino
A
Bella
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000209:etiology; D001466:Barium Sulfate; D003287:Contrast Media; D003371:Cough / Q000209:etiology; D003680:Deglutition Disorders / Q000209:etiology; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006685:Hoarseness / Q000209:etiology; D006801:Humans; D057045:Laryngopharyngeal Reflux / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012008:Recurrence; D019233:Retreatment; D063189:Symptom Assessment; D017211:Treatment Failure; D016672:Zenker Diverticulum / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*
D003287:Contrast Media; D001466:Barium Sulfate