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Review
. 2017 Mar;9(Suppl 2):S154-S162.
doi: 10.21037/jtd.2017.03.133.

Zenker's diverticulum: flexible versus rigid repair

Kristen Beard  1 , Lee L Swanström  2   3
Affiliations
Review

Zenker's diverticulum: flexible versus rigid repair

Kristen Beard et al. J Thorac Dis. 2017 Mar.

Abstract

Zenker's diverticula (ZDs) are a relatively common cause of cervical dysphagia. Diagnosis is best by a good upper GI exam though upper endoscopy should be performed as well. Treatment is either by open, transcervical approaches or trans-oral. Over the past 20 years, transoral approach has mostly replace transcervical approaches due to less pain, no scarring and a rapid recovery. Transoral approaches are either using rigid access or flexible endoscopy. Today, the most common approach is transoral stapling using a 12 mm laparoscopic linear cutting stapler. This has the drawbacks of requiring extreme neck extension, the massive size of the stapler making visualization mostly impossible and the current staple design that does not cut/staple all the way to the end of the blades-resulting in a residual pouch. Flexible endoscopy allows a more tailored approach under direct vision, the myotomy can even be extended beyond the diverticulum and onto the esophageal wall to minimize the risk of incomplete myotomy. Experienced endoscopists report high technical success and low complication. Success rates are similar but maybe slightly higher than with ridged transoral approaches or open surgery. Today, flexible endoscopic Zenkers is our preferred initial approach-with open or ridged being reserved for special indications.

Keywords: Zenkers; cricopharyngeal; diverticulum; endoscopy; myotomy.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Lateral X-ray shows the anatomy of a Zenker’s diverticulum.
Figure 2
Figure 2
Endoscopic appearance of Zenkers.
Figure 3
Figure 3
Weerda scope.
Figure 4
Figure 4
Endoscopic staple cartridges do not staple/cut all the way to the tip—leaving possible residual diverticulectomy.
Figure 5
Figure 5
Stapled diverticulectomy often leaves a residual bar.
Figure 6
Figure 6
Different cautery devices can be used to perform the procedure.
Figure 7
Figure 7
A dissecting cap is needed for endoscopic diverticulectomy.
Figure 8
Figure 8
Needle-knife division of the common wall.
Figure 9
Figure 9
Clip closure of the defect is important for extended myotomy techniques.
See this image and copyright information in PMC

References

    1. Stewart K, Sen P. Pharyngeal pouch management: an historical review. J Laryngol Otol 2016;130:116-20. 10.1017/S0022215115002285 - DOI - PubMed
    1. Laccourreye O, Ménard M, Cauchois R, et al. Esophageal diverticulum: diverticulopexy versus diverticulectomy. Laryngoscope 1994;104:889-92. 10.1288/00005537-199407000-00021 - DOI - PubMed
    1. Sen P, Lowe DA, Farnan T. Surgical interventions for pharyngeal pouch. Cochrane Database Syst Rev 2005;(3):CD004459. - PubMed
    1. Payne WS. The treatment of pharyngoesophageal diverticulum: the simple and complex. Hepatogastroenterology 1992;39:109-14. - PubMed
    1. DeMeester T, Bremner CG. Selective cricopharyngeal myotomy for Zenker's diverticulum. J Am Coll Surg 2003;196:451-2. 10.1016/S1072-7515(02)01900-2 - DOI - PubMed

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