S0933 A Cooperative Approach for Treatment of Zenker's Diverticulum

Abstract

INTRODUCTION: Symptomatic Zenker’s diverticulum management has changed from an open intervention to a less invasive transoral endoscopic route. At our center, both an ENT surgeon and gastroenterologist are present in the operating room when treating these lesions. An intraprocedural consensus is reached to undergo either stapler assisted rigid endoscopy or flexible endoscopic diverticulotomy without clipping with ENT guidance. We aimed to evaluate the real world efficacy with a combined gastroenterology-ENT approach. METHODS: This is a single center retrospective study of subjects who underwent a combined endoscopic diverticulotomy by a gastroenterologist and ENT specialist at Cleveland Clinic Florida between 2011 and 2019. Demographic and clinical data, intraprocedural findings/complications, postprocedural symptoms, recurrence rate and need for reintervention variables were extracted. Patients included in the study were >17 years old, with symptomatic typical single Zenker’s diverticulum confirmed with imaging or endoscopy. RESULTS: 63 subjects were identified. Patients were predominantly males (63.5%) and white (84.1%), with mean age 73.5 years (53–95). Most subjects presented dysphagia (98.4%), mostly to solids (79.4%). Other demographic and clinical data are described in Table 1. Mean diverticular size was 36.3 mm, intra- diverticular food in 30.1% and mean procedure time length of 38.4 minutes. All cases were performed as outpatient, without periprocedural complications. Technical success was achieved in all cases. Patients were followed for a mean of 3.24 months (0.1–22) post procedure. Other intra and post-procedural specifications are listed in Table 2. Fourteen patients (22.2%) had symptom recurrence, but only eight (12.7%) had a residual cricopharyngeal bar on imaging. Four patients had repeat endoscopic intervention and one opted open surgery. Hence, our approach was effective in 58 subjects (92%). CONCLUSION: A combined endoscopic approach by gastroenterology and ENT for symptomatic Zenker’s diverticulum management offered excellent technical and clinical success. This approach was safe and may have avoided elderly subjects with co-morbidities from undergoing two procedures at different times. This approach may provide better patient care than one performed by an unaccompanied ENT surgeon or gastroenterologist. Further studies will determine the long-term recurrence rate of this method of intervention.Table 1.: Demographic and clinical data at baseline for patients undergoing endoscopic Zenker’s diverticulotomyTable 2.: Intra and post-procedural specifications