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Flexible endoscopic treatment of Zenker’s diverticulum: a retrospective study in a single center from Turkey

  • Kerem Kenarli (Department of Gastroenterology, Ankara Bilkent City Hospital) ;
  • Bulent Odemis (Department of Gastroenterology, Ankara Bilkent City Hospital)
  • 투고 : 2024.06.30
  • 심사 : 2024.08.15
  • 발행 : 2025.03.30

초록

Background/Aims: We aimed to contribute to the literature by sharing the findings of patients treated by cricopharyngeal myotomy with a flexible endoscopic septal division. Methods: This retrospective study included patients with Zenker's diverticulum who underwent cricopharyngeal myotomy with a traditional flexible endoscopic septal division at our center. Clinical success was defined as a significant reduction in dysphagia score, and relapse was defined as an increase in dysphagia score occurring at any time over 1 month after the procedure. Results: Fifteen patients with symptomatic Zenker's diverticulum were treated with 16 cricopharyngeal myotomies. A dysphagia score of 100% indicated clinical success, but three (20%) of the patients experienced recurrence during follow-up. Conclusions: While advances in interventional flexible endoscopy have opened doors for novel treatments, cricopharyngeal myotomy based on traditional flexible endoscopic septal division remains a reliable approach for treating Zenker's diverticulum.

키워드

참고문헌

  1. Ferreira LE, Simmons DT, Baron TH. Zenker's diverticula: pathophysiology, clinical presentation, and flexible endoscopic management. Dis Esophagus 2008;21:1–8. https://doi.org/10.1111/j.1442-2050.2007.00795.x
  2. Peters JH, Mason R. The physiopathological basis for Zenker's diverticulum. Chirurg 1999;70:741–746. https://doi.org/10.1007/s001040050714
  3. Maran AG, Wilson JA, Al Muhanna AH. Pharyngeal diverticula. Clin Otolaryngol Allied Sci 1986;11:219–225. https://doi.org/10.1111/j.1365-2273.1986.tb01923.x
  4. Watemberg S, Landau O, Avrahami R. Zenker's diverticulum: reappraisal. Am J Gastroenterol 1996;91:1494–1498.
  5. Weusten BL, Barret M, Bredenoord AJ, et al. Endoscopic management of gastrointestinal motility disorders - part 2: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2020;52:600–614. https://doi.org/10.1055/a-1171-3174
  6. Mosher HP. Webs and pouches of the oesophagus, their diagnosis and treatment. Surg Gynecol Obstet 1917;25:175–187.
  7. Collard JM, Otte JB, Kestens PJ. Endoscopic stapling technique of esophagodiverticulostomy for Zenker's diverticulum. Ann Thorac Surg 1993;56:573–576. https://doi.org/10.1016/0003-4975(93)90906-X
  8. Ishioka S, Sakai P, Maluf Filho F, et al. Endoscopic incision of Zenker's diverticula. Endoscopy 1995;27:433–437. https://doi.org/10.1055/s-2007-1005736
  9. Mulder CJ, den Hartog G, Robijn RJ, et al. Flexible endoscopic treatment of Zenker's diverticulum: a new approach. Endoscopy 1995;27:438–442. https://doi.org/10.1055/s-2007-1005737
  10. Perbtani Y, Suarez A, Wagh MS. Techniques and efficacy of flexible endoscopic therapy of Zenker's diverticulum. World J Gastrointest Endosc 2015;7:206-212. https://doi.org/10.4253/wjge.v7.i3.206
  11. Jirapinyo P, Sethi A, Abu Dayyeh BK, et al. Devices and techniques for flexible endoscopic management of Zenker's diverticulum (with videos). Gastrointest Endosc 2021:94:3-13. https://doi.org/10.1016/j.gie.2021.02.020
  12. Gorrepati VS, Yang D, Draganov PV. Novel non-injection non-tunnel technique for peroral endoscopic myotomy of Zenker's diverticulum. VideoGIE 2023;8:181-182. https://doi.org/10.1016/j.vgie.2023.01.001
  13. Fair L, Ward MA. Modern approaches to treating Zenker's diverticulum. Curr Opin Gastroenterol 2023;39:333-339. https://doi.org/10.1097/MOG.0000000000000941
  14. Eckardt VF. Clinical presentations and complications of achalasia. Gastrointest Endosc Clin N Am 2001;11:281-292. https://doi.org/10.1016/S1052-5157(18)30071-0
  15. Yuan Y, Zhao YF, Hu Y, et al. Surgical treatment of Zenker's diverticulum. Dig Surg 2013;30:207-218. https://doi.org/10.1159/000351433
  16. Albers DV, Kondo A, Bernardo WM, et al. Endoscopic versus surgical approach in the treatment of Zenker's diverticulum: systematic review and meta-analysis. Endosc Int Open 2016;4:E678-E686. https://doi.org/10.1055/s-0042-106203
  17. Jones DG, Aloraini A, Gowing SD, et al. Comparing outcomes of open vs flexible and rigid trans-oral endoscopic techniques for the treatment of Zenker's diverticulum. J Am Coll Surg 2014;219(4 Suppl):e67. https://doi.org/10.1016/j.jamcollsurg.2014.07.560
  18. Ishaq S, Hassan C, Antonello A, et al. Flexible endoscopic treatment for Zenker's diverticulum: a systematic review and meta-analysis. Gastrointest Endosc 2016;83:1076-1089. https://doi.org/10.1016/j.gie.2016.01.039
  19. Li LY, Yang YT, Qu CM, et al. Endoscopic needle-knife treatment for symptomatic esophageal Zenker's diverticulum: a meta-analysis and systematic review. J Dig Dis 2018;19:204-214. https://doi.org/10.1111/1751-2980.12588
  20. Costamagna G, Iacopini F, Bizzotto A, et al. Prognostic variables for the clinical success of flexible endoscopic septotomy of Zenker's diverticulum. Gastrointest Endosc 2016;83:765-773. https://doi.org/10.1016/j.gie.2015.08.044
  21. Pang M, Koop A, Brahmbhatt B, et al. Comparison of flexible endoscopic cricopharyngeal myectomy and myotomy approaches for Zenker diverticulum repair. Gastrointest Endosc 2019;89:880-886. https://doi.org/10.1016/j.gie.2018.09.043
  22. Aslan F Yilmaz O, Sengun B, et al. A new technique in treatment of zenker diverticulum: submucosal tunneling endoscopic septum division (z-poem) versus classic endoscopic septomyotomy techniques. Gastrointest Endosc 2019;89:AB629. https://doi.org/10.1016/j.gie.2019.03.1095
  23. Zhang H, Huang S, Xia H, et al. The role of peroral endoscopic myotomy for Zenker's diverticulum: a systematic revlew and meta-analysis. Surg Endosc 2022;36:2749-2759. https://doi.org/10.1007/s00464-022-09021-3
  24. Papaefthymiou A, Benjamin N, Telese A, et al. Performance of endoscopic approaches for Zenker diverticulum management: a systematic review and meta-analysis. Endoscopy 2024;56(S02):eP552. https://doi.org/10.1055/s-0044-1783841
  25. Huberty V, El Bacha S, Blero D, et al. Endoscopic treatment for Zenker's diverticulum: long-term results (with video). Gastrointest Endosc 2013;77:701-707. https://doi.org/10.1016/j.gie.2012.12.008