Significant symptomatic relief after transoral endoscopic staple-assisted treatment of Zenker's diverticulum

Chiari, Catharina; Yeganehfar, Wafa; Scharitzer, Martina; Mittlböck, Martina; Armbruster, C; Roka, R.; Függer, R.; Wenzl, E.; Pokieser, Peter; Bischof, G.

doi:10.1007/s00464-002-9092-3

Cited by 18 publications

(6 citation statements)

References 13 publications

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“…This was considered in our case of a diverticulum in the lower third of the esophagus (also in consultation with the otorhinolaryngologist) but, because of its specific length and design, the stapling device is not feasible for the typical location of Zenker's diverticulum within the gastrointestinal tract, at the esophageai introitus. In addition, though the method has been extensively described as safe with a low morbidity rate (low risk of bleeding and perforation) of between 4% [25] and 7.7% [26], there is still a risk of vocal fold paresis (palsy of the recurrent laryngeal nerve) resulting from traction on the recurrent laryngeal nerve(s) secondary to an unfavorable patient anatomy [27]. Therefore, anatomical considerations may prevent its use [28] as in our case.…”

Section: Discussionmentioning

confidence: 56%

Successful endoscopic treatment of an esophageal duplication cyst

Will

Meyer

Bosseckert

2005

Scandinavian Journal of Gastroenterology

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Duplication cysts of the gastrointestinal tract are rare, particularly in adults. Endoscopic minimally invasive treatment is still a challenging approach even in the endoscopically accessible sections of the gastrointestinal tract. In a 25-year-old patient suffering from dysphagia, an endoscopy and subsequent endosonography revealed a spherical duplication cyst in the lower third of the esophagus, which prompted us to puncture the cyst and subsequently to perform a fenestration (marsupialization; diameter 1 cm) in the anterior wall of the cyst, resulting in permanent drainage of the cystic fluid. Because of the recurrent complaints of the patient after 6 weeks, the anterior wall of the duplication cyst, the former esophageal wall, was partially resected, resulting in a permanent 4-cm opening including the cystic cavity into the esophageal lumen. Thereafter, there were no further complaints from the patient and the findings in the follow-up endoscopy were normal. A successful endoscopic intervention for this type of gastrointestinal duplication cyst is described for the first time. The minimally invasive resection of the anterior wall of the esophageal duplication cyst, simultaneously with the former regular wall at this segment of the esophagus, resulted in permanent inclusion of the cystic cavity into the esophageal lumen with no disadvantageous passage of fluid and food through the lower esophagus or changes in the former cystic epithelium. This method is considered to be feasible and a reasonable treatment alternative to the more invasive surgical approach.

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Section: Discussionmentioning

confidence: 56%

Successful endoscopic treatment of an esophageal duplication cyst

Will

Meyer

Bosseckert

2005

Scandinavian Journal of Gastroenterology

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“…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,…”

Section: Search Resultsmentioning

confidence: 99%

Surgical Treatment of Zenker's Diverticulum

Yao¹,

Zhao²,

Hu³

et al. 2013

Dig Surg

154

152

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Background: Different surgical techniques have been indicated for the management of Zenker's diverticulum (ZD), including diverticulectomy, diverticulopexy, and diverticular inversion, with or without myotomy, and myotomy alone. More recently, minimally invasive techniques (such as the transoral endoscopic approach) have become increasingly reliable for this disorder. We therefore conducted this systematic review in order to gain a profound understanding of the current trend and evidence in surgical management of ZD. Methods: Medline and PubMed were searched to identify studies on surgical intervention of ZD published in English between January 1990 and March 2011. Results: We identified 6,915 patients from 93 studies evaluating the effect of the surgical intervention for ZD. No randomized controlled trials comparing one technique with another were identified. Conclusion: Diverticulectomy with myotomy has become the mainstream treatment option for ZD. In certain selected patients, endoscopic diverticulotomy may offer some advantages over open surgery, such as less trauma and a lower complication rate. It is important to individualize optimal therapy for each patient. More randomized controlled trials with long-term follow-up results are required to draw a valid conclusion on the best surgical intervention modality for ZD.

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“…Endoscopic procedure was not performed if the diverticulum was < 2 cm. In this situation, a complete myotomy is not guaranteed 5 . We also changed to open surgery if the exposure was not sufficient.…”

Section: Methodsmentioning

confidence: 99%

Outcome and quality of life after open surgery versus endoscopic stapler-assisted esophagodiverticulostomy for Zenker’s diverticulum

Wirth

Kern

Guenin

et al. 2006

Diseases of the Esophagus

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Two techniques for treatment of Zenker's diverticulum, endoscopic stapler-assisted esophagodiverticulostomy and open cricopharyngeal myotomy by transcervical approach, were compared with regard to patient satisfaction and quality of life. Between January 1994 and December 2004 a total of 47 patients with Zenker's diverticulum underwent surgery in our department. Besides the usual retrospective evaluation of details of surgery, all patients were sent a questionnaire on their actual complaints and quality of life according to the Gastrointestinal Quality of Life Index (GIQLI). Twenty patients had the endoscopic procedure (Group A), and 27 the open procedure (Group B). The preoperative symptoms were dysphagia in 96%, regurgitation of undigested food in 60%, cough in 19%, and pneumonia caused by recurrent aspiration in 9%. The length of surgery was on average 32 min (range 5-70 min) in Group A and 106 min (range 45-165 min) in Group B, and the length of hospital stay was 5.5 days (range 1-10 days) and 12.3 days (range 7-25 days), respectively. The results of the questionnaire showed that the preoperative symptoms had disappeared in up to 83%, and 91% in Group A and 100% in Group B would be willing to undergo surgery again. The mean GIQLI was 123 points in Group A and 118 points in Group B (healthy volunteers in the literature, 125 points). Both techniques showed good results in a long-term follow-up with regard to relief of symptoms and patient satisfaction. Both groups had an excellent Gastrointestinal Quality of Life Index, comparable to that of a healthy standard population.

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Significant symptomatic relief after transoral endoscopic staple-assisted treatment of Zenker's diverticulum

Abstract: Our results confirm that minimal invasive treatment of Zenker's diverticulum is a safe method and provides significant symptomatic relief.

Cited by 18 publications

References 13 publications

Successful endoscopic treatment of an esophageal duplication cyst

Successful endoscopic treatment of an esophageal duplication cyst

Surgical Treatment of Zenker's Diverticulum

Outcome and quality of life after open surgery versus endoscopic stapler-assisted esophagodiverticulostomy for Zenker’s diverticulum

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