3556 Endoscopic treatment of zenker's diverticulum.

Abstract

Background - The treatment of Zenker's diverticulum had been done surgically using several techniques as diverticulotomy with or without cricopharyngeal myotomy, only cricopharyngeal myotomy and diverticulopexy with myotomy. Recently, three studies showed the possibility of endoscopic diverticulotomy with cricopharyngeal myotomy as an alternative therapy to surgical treatment. Patients and methods - Since September 1997, 12 patients (10 men and 2 women; 51 to 85 years of age) underwent an endoscopic diverticulotmy. All patients had severe dysphagia (average of 6,25 in a 0 to 10 score), 11 had regurgitation, 7 had respiratory symptoms with chronic cough and 2 had recurrent aspiration pneumonia. The diverticulum size were small (less than 2 cm) in 2, medium (2 to 4 cm) in 4 and large (over 4 cm) in 6 patients. The procedure consisted on endoscopic incision of the septum untill the diverticulum base with a needle knife, using cutting/coagulation current. It was performed with sedation as a routine endoscopic examination. All patients were clinically and endoscopically evaluated 30 days after the procedure. When there were symptoms and a septum, a new procedure was performed. Oral intake of liquid food was begun in the first day after the operation. All patients received antibiotics for 24 hours. Results - Treatment using a mean of 1,41 (1 to 3) sessions per patient was successful. Three complications (1 cervical emphysema and 2 hemorrhage) were managed clinically. Dysphagia disappeared in 11 patients (6 with one session and 5 with two sessions) and the respiratory symptoms disappeared in all them, with no recurrence. Conclusion - The endoscopic diverticulotomy is an alternative and safe procedure to open surgery, with equivalent results, and should be considered as a therapy for Zenker's diverticulum, especially for patients with high surgical risk.