Endoscopic treatment of Zenker's diverticulum with soft diverticuloscope : a first tunisian experience

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Published Nov 26, 2015
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Vol. 93 No. 7 (2015): Issue Jul 2015

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Sondes Bizid
Riadh Bouali
Sana Lahmar
Hatem Ben Abdallah
Nabil Abdelli

Abstract

SUMMARY
Introduction: Zenker’s diverticulum is an acquired hernia from the posterior pharyngeal mucosa developed in the pharyngo-esophageal junction. The gold standard for diagnosis is pharyngo-esophageal barium swallow study. Open surgery with cricopharyngeal myotomy has long been the conventional treatment. Actually, endoscopic treatment is an efficient alternative to resolve the problem with shorter surgery duration and less complication.
Aim: We report 3 cases of patients with Zenker’s diverticulum treated with endoscopic approach in our department between 2013 and 2014.
Case report: There were three men aged 71, 79 and 62 years admitted to our department with symptomatic Zenker’s diverticulum. Predominant symptoms were dysphagia and regurgitation. Diverticulotomy with a flexible endoscope was performed for all patients, using argon plasma coagulation in the first case and a
needle-knife in the two others. Hemostatic clips were placed at the end of the procedure. There was no complication in the last two cases. Perforation at the left lateral side of the cervical diverticulum was observed in the first patient solved by diet and antibiotics. We performed a pharyngo-esophageal barium swallow study before and after the intervention in all patients showing significant regression of the diverticulum and we observed a complete regression of clinical symptoms.
Conclusion: Treatment with endoscopic approach using a flexible endoscope and a diverticuloscope for good exposure of the diverticulum is a safe procedure offering a rapid improvement of symptoms with a lower risk of complications and a shorter duration of hospitalization compared to surgical treatment.

Keywords:

Zenker's diverticulum - Treatment - Endoscopy

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References

  1. Charachon A. Traitement endoscopique du diverticule de Zenker. Acta Endosc 2013;43:105-8.
  2. Flamenbaum M, Becaud P, Genes J, Cassan P. Traitement endoscopique du diverticule de Zenker associé au laser CO2. Gastroenterol Clin Biol 1997;21:950-4.
  3. Bizzotto A, Iacopini F, Landi R, Costamagna G. Zenker's diverticulum: exploring treatment options: Acta Otorhinolaryngol Ital 2013;33:219-29.
  4. Buc E. Les diverticules de l'oesophage : Acta Endosc 2006;36:605-15
  5. Veenker EA, Andersen PE, Cohen JI. Cricopharyngeal spasm and Zenker's diverticulum: Head Neck 2003;25:681-94.
  6. Aggerholm K, Illum P. Surgical treatment of Zenker's Diverticulum. J Laryngol Otol 1990; 104:312-4.
  7. Lerut T, Van Raemdonck D, Guelinckx P, Van Clooster P, Gruwez JA, Dom R, et al. Pharyngo-esophageal diverticulum (Zenker's): clinical, therapeutic and morphological aspects. Acta Gastroenterol Belg 1990;53:330-7.
  8. Rahul S. Patient reported outcomes in endoscopic and open transcervical treatment for Zenker's diverticulum. Laryngoscope 2014;124:119-25.
  9. Huberty V, El Bacha S, Blero D, Le Moine O, Hassid S, Devière J. Endoscopic treatment for Zenker's diverticulum: long-term results (with video). Gastrointest Endosc. 2013;77:701-7.
  10. Herrero Egea A, Pérez Delgado L, Tejero-Garcés Galve G, Guallar Larpa M, Orte Aldea C, Ortiz García A. Treatment of Zenker's diverticulum: comparison of different techniques. Acta Otorrinolaringol Esp 2013;64:1-5.
  11. Vogelsang A, Preiss C, Neuhaus H, Schumacher B. Endotherapy of Zenker's diverticulum using the needle-knife technique: long-term followup. Endoscopy 2007;39:131-6.
  12. Evrard S, Le Moine O, Hassid S, Devière J. Zenker's diverticulum: a new endoscopic treatment with a soft diverticuloscope. Gastrointest Endosc. 2003;58:116-20.