Endoscopically stapled diverticulostomy for Zenker’s diverticulum: results of a multidisciplinary team approach

Abstract

A variety of open and endoscopic surgical approaches for the treatment of Zenker's diverticulum have been described. In recent years, growing evidence has shown that the endoscopic techniques are superior to the open approaches in many aspects. Among the endoscopic techniques, endoscopically stapled diverticulostomy (ESD) appears to have better efficacy and safety than the other endoscopic techniques. This study retrospectively reviewed the medical records of all the patients with Zenker's diverticulum treated surgically by the same team, which involved an ear, nose, and throat surgeon and an endoscopic surgeon. From January 2002 to March 2008, 55 consecutive patients with Zenker's diverticulum underwent 60 ESDs. The mean follow-up time was 32.6 months (range, 1-72 months). The mean operative time was 21.8 min (range, 5-45 min), and the average hospital stay was 2.24 days (range, 1-30 days). The treatment was technically feasible for 51 patients (93%), and initial symptom relief without recurrence was achieved for 46 patients (90.2%) after a single procedure. Five patients with recurrent symptoms underwent a successful revision ESD, with a 100% success rate among the patients for whom the procedure was technically feasible. Only two major postoperative complications (3.64%) occurred: one esophageal perforation and pneumomediastinum and one severe esophageal edema. Both patients had complete resolution of their complications with conservative treatment and no long-term sequela. The findings showed endoscopic stapled diverticulostomy to be both safe and effective. Compared with the historical results of open diverticulectomy and myotomy, the reported procedure has fewer complications and better outcomes and should become the procedure of choice for the treatment of most patients with a diagnosis of Zenker's diverticulum.