Endoscopic management of Zenker's diverticulum: factors predictive of success or failure. The Annals of otology, rhinology, and laryngology [Ann Otol Rhinol Laryngol] Journal article | | Title | Endoscopic management of Zenker's diverticulum: factors predictive of success or failure. | | Author(s) | Visosky AM, Parke RB, Donovan DT | | Institution | Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas 77030, USA. | | Source | Ann Otol Rhinol Laryngol 2008 Jul; 117(7):531-7. | | MeSH | Adult
Aged
Aged, 80 and over
Esophageal Sphincter, Upper
Esophagoscopy
Female
Humans
Male
Middle Aged
Postoperative Complications
Recurrence
Reoperation
Retrospective Studies
Risk Factors
Treatment Outcome
Zenker Diverticulum
| | Abstract | OBJECTIVES: We review our experience with endoscopic management of Zenker's diverticulum. We sought to analyze and determine risk factors for success or failure of endoscopic diverticulum treatment.
METHODS: We performed a retrospective review of 72 consecutive patients who underwent attempted endoscopic management of a Zenker's diverticulum between January 2000 and April 2006. The procedures were performed by either of 2 otolaryngologists. There were 50 men and 22 women ranging in age from 44 to 93 years. A total of 85 procedures were performed. The medical records were reviewed for preoperative diverticulum size (small, 1 to 2 cm; moderate, 2.1 to 3.0 cm; and large, more than 3.0 cm), intraoperative diverticulum characteristics, patient anatomic limitations that prevented adequate endoscopic visualization, surgical complications, and management of recurrences.
RESULTS: Of our 72 patients, 61 (85%) were able to undergo endoscopic cricopharyngeal myotomy with diverticulum elimination. Of the 61 endoscopic procedures, 47 (77%) resulted in complete symptom resolution. The most common risk factors for recurrence were diverticulum size (more than 3 cm) and amount of redundant mucosa. Of the 14 patients with a recurrence, 10 (71%) underwent a repeat procedure. Six of the 14 (43%) had a successful excision via a cervical approach, and 4 of the 14 (29%) underwent a repeat endoscopic myotomy. There was 1 major complication (esophageal tear), and there were 3 minor complications (mucosal abrasions).
CONCLUSIONS: Most patients with a Zenker's diverticulum are good candidates for endoscopic management. In our series, 84% of those who underwent endoscopic treatment ultimately achieved relief of symptoms. The patient morbidity is minimal. A large diverticulum with redundant mucosa is a risk factor for recurrence after endoscopic treatment. | | Language | eng | | Pub Type(s) | Journal Article
| | PubMed ID | 18700430 |
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