Therapie des Zenker-Divertikels

Zusammenfassung

Das Zenker-Divertikel ist ein Pseudodivertikel mit Aussackung der Mukosa oberhalb des oberen Ösophagussphinkters. Die Symptomatik besteht in einer Dysphagie mit Regurgitieren von Speisen. Eine generelle Richtlinie zur Behandlung des Zenker-Divertikels existiert nicht. Für die Behandlung stehen momentan drei verschiedene Verfahren zur Verfügung. Das wahrscheinlich am häufigsten durchgeführte Therapieverfahren ist die transzervikale Resektion des Divertikelsackes. Ein weiteres Verfahren besteht in der endoskopischen Behandlung. Hierbei werden die flexibel-endoskopischen von den starr-endoskopischen Verfahren unterschieden. In dieser Arbeit werden die verschiedenen Verfahren dargestellt und die Ergebnisse aus der bislang veröffentlichten Literatur sowie eigene Daten miteinander verglichen. Unter Einschränkungen können folgende Schlussfolgerungen gezogen werden: Die endoskopischen Verfahren weisen ein kleineres Komplikationsspektrum auf als die klassische Operation. Flexibel endoskopische Methoden sind besser geeignet für risikoreiche Patienten und sie haben keine Einschränkung bei Patienten mit schweren degenerativen HWS-Veränderungen oder Divertikeln < 2 cm. Operative und starr-endoskopische Verfahren erzielen in der Regel bereits nach einer Behandlung gute Ergebnisse. Die flexibel-endoskopische Koagulation mit APC scheint mehr Behandlungssitzungen zu benötigen als die Inzision mit einem Nadelmesser.

Abstract

Zenker's Diverticulum is a pseudodiverticulum with herniation of the mucosa above the upper oesophageal sphincter. Dysphagia with regurgitation of swallowed food is the most common symptom. Three different treatment modalities are available. The most common treatment option is surgical resection of the diverticulum. Other treatment modalities are endoscopic therapy, using flexible or rigid endoscopes. So far, there are no guidelines with regards to the treatment of Zenker's diverticulum. We describe the different management strategies of Zenker's diverticulum and compare the results available from the literature with our own data. With exceptions, the following conclusions are made: Endoscopic procedures have a lower complication rate as compared to surgery. Treatment of Zenker's diverticulum with flexible endoscopy is recommended for patients with high operative risk and severe degenerative cervical spondylosis as well as for patients with a diverticulum smaller than 2 cm. Surgery and treatment with rigid endoscopes needed only single treatment session to yield good results. More treatment sessions are necessary using argon plasma coagulation (APC) as compared to myotomy performed with a needle knife.

Zenker-Divertikel - Ösophagus-Divertikel - Dysphagie

Zenker's diverticulum - hypopharyngeal diverticulum - dysphagia

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