Indication for the endoscopic treatment of Zenker’s diverticula

Abstract

: Zenker’s diverticulum (ZD) is a false pulsion diverticulum located in Killian’s triangle. It accounts for about 70% of all esophageal diverticula. ZD incidence is uncommon, and it is mostly present in the elderly population. Although the pathophysiology has not been completely elucidated, an impaired relaxation of the cricopharyngeal muscle (CPM) has been identified as the leading mechanism. For this reason, the current therapeutic modalities are based on CPM myotomy to eliminate diverticular bolus retention, improve bolus flow, relieve outflow obstruction, and mitigate neuromotor impairment. The conventional open approach through a left cervicotomy has been mostly replaced by transoral techniques using either rigid endoscopy or flexible endoscopes. The minimally invasiveness of these techniques allows for reinterventions in case of recurrence. Endoscopic techniques present several advantages in terms of lower risk of adverse events, can be accomplished without the need for general anesthesia and neck hyperextension, and provide for a rapid patient recovery. The recent introduction of cutting-edge technology Z-POEM allows through a direct septal visualization for a complete myotomy, leading to a lower recurrence rate and higher symptoms resolution than endoscopic septotomy. The potential advantages also account for lower complication rates making it a promising technique.