Endoscopy 2007; 39(2): 137-140
DOI: 10.1055/s-2006-945118
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Treatment of Zenker’s diverticulum through a flexible endoscope with a transparent oblique-end hood attached to the tip and a monopolar forceps

P.  Christiaens1 , W.  De Roock1 , A.  Van Olmen1 , V.  Moons1 , G.  D'Haens1
  • 1Department of Internal Medicine and Gastroenterology, Imeldaziekenhuis Bonheiden, Belgium
Further Information

Publication History

eingereicht 3 April 2006

akzeptiert 2 November 2006

Publication Date:
11 January 2007 (online)

Background and study aims: Zenker’s diverticulum was commonly treated by means of external transcervical diverticulectomy, myotomy or diverticulopexy, or by means of an endoscopic myotomy through a rigid endoscope. Gastroenterologists first described flexible endoscopic therapy for Zenker’s diverticulum in 1995. In our single-center study we report the safety and feasibility of endoscopic myotomy through a flexible endoscope, performed at a secondary referral centre.

Patients and methods: A series of 21 patients with Zenker’s diverticulum were treated using a flexible endoscope with a transparent oblique-end hood attached to the tip and a monopolar coagulation forceps. Relief of the dysphagia was the main outcome measure with evaluation of safety and complications. Dysphagia was graded on a scale of 0 to 4 before and after treatment. General anesthesia was not used.

Results: Access to the esophagus was attained without problems in all patients. Oral feeding was resumed the following day. Complete relief of dysphagia was reported by all patients after 1 month. Dysphagia recurred in two patients (9.5 %) after the first session. These patients were successfully treated again in the same way. Adverse events were limited to transient cervical emphysema in a single patient.

Conclusions: This endoscopic technique is an efficient, safe and minimally invasive method for the treatment of Zenker’s diverticulum. General anesthesia is not necessary and oral feeding can be resumed the next day. In view of the excellent results and minimal complications, it can be considered a safe alternative for the treatment of Zenker’s diverticulum.

References

  • 1 Zenker F A, Zeimssen von H. Krankheiten des Oesophagus.  In: Zeimssen H (ed). Handbuch der Speciellen Pathologie und Therapie, vol. 7. Leipzig; FC Vogel 1877: 187
  • 2 Bremner C G, De Meester T R. Endoscopic treatment of Zenker’s diverticulum.  Gastrointest Endosc. 1999;  49 126-127
  • 3 Lerut T, Van Raemdonck D, Guelinckx P. et al . Pharyngo-esophageal diverticulum (Zenker’s). Clinical, therapeutic and morphological aspects.  Acta Gastroenterol Belg. 1990;  53 330-337
  • 4 Payne W S. The treatment of pharyngoesophageal diverticulum. The simple and complex.  Hepatogastroenterology. 1992;  39 109-114
  • 5 Dohlman G, Mattsson O. The endoscopic operation for hypopharyngeal diverticula.  Arch Otolaryngol. 1960;  71 744-752
  • 6 Mulder C JJ, den Hartog G, Robijn R J, Thies J E. Flexible endoscopic treatment of Zenker’s diverticulum: a new approach.  Endoscopy. 1995;  27 438-442
  • 7 Ishioka S, Sakai P, Maluf Filho F, Melo J M. Endoscopic incision of Zenker’s diverticulum: a new approach.  Endoscopy. 1995;  27 438-442
  • 8 Evrard S, Le Moine O, Hassid S, Deviere J. Zenker’s diverticulum: a new endoscopic treatment with a soft diverticuloscope.  Gastrointest Endosc. 2003;  58 116-120
  • 9 Sakai P, Ishioka S, Maluf-Filho F. et al . Endoscopic treatment of Zenker’s diverticulum with an oblique-end hood attached to the endoscope.  Gastrointest Endosc. 2001;  54 760-763
  • 10 Costamagna G, Mutignani M, Tringali A, Perri V. Treatment of Zenker’s diverticulum with the help of a plastic hood attached to the endoscope.  Gastrointest Endosc. 2002;  56 611-612; author reply 612
  • 11 Collard J-M, Otte J-B, Kestens P J. Endoscopic stapling technique of esophagodiverticulostomy for Zenker’s diverticulum.  Ann Thorac Surg. 1993;  56 573-576
  • 12 Hashiba K, de Paula A L, da Silva J GN. et al . Endoscopic treatment of Zenker’s diverticulum.  Gastrointest Endosc. 1999;  49 93-96
  • 13 Mulder C J, Costamagna G, Sakai P. Zenker’s diverticulum: treatment using a flexible endoscope.  Endoscopy. 2001;  33 991-997
  • 14 Waye J D, Sakai P, Belsaguy A F. et al . Treatment of Zenker’s diverticulum.  Gastrointest Endosc. 2001;  54 135-137
  • 15 Mulder C JJ. Zenker’s diverticulum: treatment with a flexible endoscope.  Gastrointest Endosc. 1999;  50 596-597
  • 16 Aggerholm K, Illum P. Surgical treatment of Zenker’s diverticulum.  J Laryngol Otol. 1990;  104 312-314
  • 17 Mouroux J, Benchimol D, Santini J. et al . Diverticules pharyngo-esophagiens.  Ann Chir. 1991;  45 391-395
  • 18 Konowitz P M, Biller H F. Diverticulopexy and cricopharyngeal myotomy: treatment for high- risk patients with a pharyngoesophageal (Zenker’s) diverticulum.  Otolaryngol Head Neck Surg. 1989;  100 146-153
  • 19 Thorne M, Harris P, Marcus K, Teknos T N. Bilateral vocal fold paresis after endoscopic stapling diverticulotomy for Zenker’s diverticulum.  Head Neck. 2004;  26 294-297

P. Christiaens, MD

Department of Internal Medicine and Gastroenterology

Imeldaziekenhuis Bonheiden
Imeldalaan 9
2820 Bonheiden
Belgium

Fax: +32-15-505010

Email: paul.christiaens@imelda.be

    >