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. 2021 Mar 16:2021:9237617.
doi: 10.1155/2021/9237617. eCollection 2021.

Endoscopic Treatment of Zenker's Diverticulum: Comparable Treatment Outcomes in Treatment-Naïve and Pretreated Patients

Johannes Manzeneder  1 , Christoph Römmele  1 , Carolin Manzeneder  1 , Alanna Ebigbo  1 , Helmut Messmann  1 , Stefan Karl Goelder  1
Affiliations

Endoscopic Treatment of Zenker's Diverticulum: Comparable Treatment Outcomes in Treatment-Naïve and Pretreated Patients

Johannes Manzeneder et al. Gastroenterol Res Pract. .

Abstract

Background and aims: Flexible endoscopic treatment plays an important role in the treatment of Zenker's diverticulum (ZD). This study analyzes long-term symptom control and the rate of adverse events in treatment-naïve patients and patients with recurrence, using the stag beetle knife junior (sb knife jr).

Methods: From August 2013 to May 2019, 100 patients with symptomatic ZD were treated with flexible endoscopy using the sb knife jr. Before treatment, as well as 1 and 6 months afterwards, symptoms were obtained by a nine-point questionnaire, with symptoms weighted from 0 to 4.

Results: Overall, 126 interventions were performed. The median follow-up period was 41 months (range 7-74). For the three most frequent symptoms, regurgitation, dysphagia, and dry cough, a significant reduction of the mean score could be achieved, from 2.85/3.45/2.85 before the initial treatment to 0.56/1.09/0.98 6 months later. 17 patients were retreated because of recurrence. Out of these, 12 patients underwent a 2nd, 4 patients a 3rd, and 1 patient a 4th session, respectively. The mean dysphagia score for successfully treated patients could be reduced from initially 2.34 to 0.49/0.33/0.67 after the 1st/2nd/3rd session, the frequency of dysphagia from 3.45 to 0.92/1.00/1.33, and the score for regurgitations from 2.85 to 0.35/1.00/0.67. In first-line treatment, as well as in retreatment, no severe adverse event occurred.

Conclusion: Patients with ZD can be treated safely and effectively with the sb knife jr. Retreatment leads to equal symptom relief as compared to a successful first-line treatment and is not associated with a higher rate of adverse events.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
(a) Symptomatic ZD of a 73-year-old male patient. (b) Fixation of the diverticulum with an overtube. (c) Incision of the mucosa and the upper muscular fibers of the diverticular bridge. (d) Cutting down the diverticular bridge with the sb knife jr. (e) Final result after the first session. (f–j) Second session because of recurrence 16 months later.
Figure 2
Figure 2
Flow chart of patients with recurrence. Recurrence: recurring symptoms after a temporary improvement. ∗103 sessions in 100 patients due to three two-stage treatments.
Figure 3
Figure 3
Dysphagia score of patients with and without recurrence after each session. Mean dysphagia score prior to initial treatment and six months after each session. Dysphagia score: 0: no dysphagia, 1: solid food, 2: soft food, 3: fluids, and 4: aphagia. ∗∗∗t-test significance p < 0.001, ∗t-test significance p < 0.05.
See this image and copyright information in PMC

References

    1. Colombo-Benkmann M., Unruh V., Kocher T., Krieglstein C., Senninger N. Modern treatment options for Zenker’s diverticulum: indications and results. Zentralblatt für Chirurgie . 2003;128(3):171–186. doi: 10.1055/s-2003-38528. - DOI - PubMed
    1. van Overbeek J. J. Pathogenesis and methods of treatment of Zenker’s diverticulum. The Annals of Otology, Rhinology, and Laryngology . 2003;112(7):583–593. doi: 10.1177/000348940311200703. - DOI - PubMed
    1. Brueckner J., Schneider A., Messmann H., Gölder S. K. Long-term symptomatic control of Zenker diverticulum by flexible endoscopic mucomyotomy with the hook knife and predisposing factors for clinical recurrence. Scandinavian Journal of Gastroenterology . 2016;51(6):666–671. doi: 10.3109/00365521.2015.1130165. - DOI - PubMed
    1. Ishioka S., Sakai P., Maluf Filho F., Melo J. M. Endoscopic incision of Zenker’s diverticula. Endoscopy . 1995;27(6):433–437. doi: 10.1055/s-2007-1005736. - DOI - PubMed
    1. Mulder C. J., den Hartog G., Robijn R. J., Thies J. E. Flexible endoscopic treatment of Zenker’s diverticulum: a new approach. Endoscopy . 1995;27(6):438–442. doi: 10.1055/s-2007-1005737. - DOI - PubMed

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