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. 2019 Jan 30;4(2):87-90.
doi: 10.1016/j.vgie.2018.12.007. eCollection 2019 Feb.

Management of Zenker's diverticulum using flexible endoscopy

Howard Shihao Fan  1   2 , Bethany Stavert  1   2 , Daniel Leonard Chan  1   2 , Michael Leonard Talbot  1   2   3
Affiliations

Management of Zenker's diverticulum using flexible endoscopy

Howard Shihao Fan et al. VideoGIE. .

Abstract

Background and aims: Zenker's diverticulum is a false diverticulum through Killian's dehiscence. Symptoms include halitosis, dysphagia, regurgitation, cough, and aspiration pneumonia. Treatment options include open transcervical cricopharyngeal myotomy, trans-oral rigid endoscopic stapling, and minimally invasive endoscopic myotomy. Although open surgical techniques have historically been the criterion standard for treatment, endoscopic options have become increasingly used. We propose the use of flexible endoscopy in the management of Zenker's diverticulum.

Methods: We present a retrospective case series of 9 patients undergoing endoscopic cricopharyngeal myotomy from 2014 to 2018 using our endoscopic technique.

Results: We demonstrate that endoscopic technique provided adequate symptomatic relief in 7 of 9 patients, with no operative adverse events.

Conclusions: Cricopharyngeal myotomy using flexible endoscopy is a safe and effective technique for the management of Zenker's diverticulum. Potential benefits of this approach include shorter operative times, shorter postoperative admissions, and earlier progression of diet. Initial treatment with endoscopic technique does not preclude future open repairs.

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Figures

Figure 1
Figure 1
The Zenker’s diverticulum is confirmed on endoscopy.
Figure 2
Figure 2
Cricopharyngectomy is performed with needle-knife.
Figure 3
Figure 3
Adequate dissection is performed to allow the inferior aspect of the diverticulum to freely communicate with the esophagus.
Figure 4
Figure 4
Nasogastric tube inserted to guide the gastroscope to the Zenker’s diverticulum.
Figure 5
Figure 5
Preoperative barium swallow image showing contrast material flowing down the esophagus.
Figure 6
Figure 6
Preoperative barium swallow image showing contrast material collecting in the Zenker’s diverticulum.
Figure 7
Figure 7
Postoperative barium swallow image showing contrast material flowing down the esophagus.
Figure 8
Figure 8
Preoperative barium swallow image showing no contrast material collecting in the Zenker’s diverticulum.
See this image and copyright information in PMC

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