Endoscopic stapling diverticulostomy for Zenker's diverticulum

Abstract

Endoscopic stapling diverticulostomy (ESD) using an endostapler is a modification of the standard endoscopic treatment of Zenker's diverticulum (ZD). It is characterized by complete myotomy of the upper esophageal sphincter, with division of the common wall between diverticulum and esophagus, followed by immediate simultaneous closure of the divided edges with the staples. ESD was performed on 21 patients with ZD between January 1996 and October 1997. The results were then evaluated. Operation time averaged 22 min. Wide opening of the diverticulum and excellent hemostasis were achieved. All of the patients but one, who died postoperatively of myocardial infarction, resumed oral intake without any evidence of cervical sepsis or mediastinitis. Complete relief of dysphagia was achieved in all 20 patients. Hospital stay averaged 4.7 days (range, 2-7 days). The patients were followed up after ESD for a median time period of 12 months. No relapses were recorded. ESD is an effective endoscopic treatment for ZD that entails a low risk of complications and requires only a short period of hospitalization.

Surgical Treatment of Zenker's Diverticulum

“…We identified 6,915 patients from 93 studies evaluating the effect of the surgical treatment for ZD, including 52 studies [8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59] (n = 3,336) on endoscopic surgeries, 22 [60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81] (n = 2,204) on open surgeries, and 19 [3,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,…”

Tailored approach to Zenker's diverticula

“…With this technique, the anterior wall of the diverticulum and the posterior wall of the esophagus were sealed with a double row of staples along the cut edges, thus preventing leakage, mediastinitis, or bleeding [2]. This procedure rapidly became widespread and is now often considered the treatment of choice for ZD [11,14].So far, however, there has been no prospective randomized trial demonstrating that endoscopic diverticulostomy is superior to traditional surgery. Moreover, given the rarity of the disease and its prevalence in elderly patients (often with severe comorbidities), it is unlikely that randomized studies will be performed in the near future.…”

Endoscopic Diverticulotomy of Zenker's Diverticulum: Management and Complications

“…One has to be aware that the mediastinum is opened up when the endoscopic resection of Zenker's diverticulumÐeither by diathermy, endoscopic scissors, or CO 2 laserÐis done properly. In the future, the endoscopic stapling technique could help to prevent these problems, at least in those cases where the size of the diverticular bridge is suitable to use the stapler [34].…”