Abstract
To evaluate the postoperative outcome of patients with pharyngoesophageal diverticulum submitted to surgical and endoscopic treatments. We retrospectively analyzed 36 patients with pharyngo-esophageal diverticulum treated at the Hospital of the Medical School of Botucatu - UNESP. Patients were divided into two groups, depending on the treatment: group 1 (n = 24): diverticulectomy associated myotomy through a left cervicotomy; group 2 (n = 12): endoscopic diverticulostomy with linear stapler. Operative mortality was zero in both groups. Early complications: group 1 - two patients developed cervical fistula and two, hoarseness; group 2 - none. Late complications: group 1 - none; group 2: recurrence of dysphagia in four patients (p = .01). Mean follow-up was 33 months for group 1 and 28 months for group 2. Both procedures were effective in remission of dysphagia. Surgical treatment showed superiority to endoscopy, with resolution of dysphagia with a single procedure. Endoscopic treatment should be reserved for the elderly and those with comorbidities.
Highlights
D escribed in 1764 by Ludlow Abrahan 1, pharyngoesophageal diverticulum (PED) is the most common esophageal diverticulum
The 36 patients were divided into two groups, depending on the approach adopted: Group 1 (n = 24): diverticulectomy associated with cricopharyngeal myotomy, Group 2 (n = 12): diverticulostomy performed with linear stapler
In the late follow-up, four patients (33.3%) complained of recurrent dysphagia, requiring a new endoscopic procedure, with symptom improvement. In this retrospective study we studied, in a comparative manner, the clinical and therapeutic aspects of patients with PED undergoing two types of treatment, surgical and endoscopic
Summary
D escribed in 1764 by Ludlow Abrahan 1, pharyngoesophageal diverticulum (PED) is the most common esophageal diverticulum. This condition receives the name of Zenker’s diverticulum 2, a German pathologist who, in association with Von Ziensen, published the first 27 cases, 5 from their own series. The PED is uncommon, representing three to 5% of esophageal diseases, being more frequent in males 3-5. The most accepted mechanism is due to increased pressure in pharyngeal lumen, causing herniation of the mucosa through a weak point in the esophageal muscle (Killian’s triangle). This is a space between the inferior pharyngeal constrictor and the cricopharyngeal muscles 7
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