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Evaluation and Treatment of Zenker’s Diverticulum

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Esophageal Diseases

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Abstract

The goal of this chapter is to describe the pathophysiology of Zenker’s diverticulum, their clinical presentation, and indications for treatment and provide an overview of the surgical management of patients with this rare esophageal pathology. Treatment approaches discussed include open transcervical resection, endoscopic stapled diverticulotomy, endoscopic harmonic scalpel diverticulotomy, and flexible endoscopic diverticulotomy. Finally, a comparison of the open and endoscopic approaches will be provided.

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Selected Reading

  1. Adam SI, Paskhover B, Sasaki CT. Laser versus stapler: outcomes in endoscopic repair of Zenker diverticulum. Laryngoscope. 2012;122:1961–6. Endoscopic CO2 laser and endoscopic stapling groups both exhibited significant symptom improvement, but the laser group scores showed greater improvement. There were significantly more recurrences in the laser group, and significantly longer hospital stay and time to oral intake in the stapler group.

    Article  PubMed  Google Scholar 

  2. Bergeron JL, Long JL, Chhetri DK. Dysphagia characteristics in Zenker’s diverticulum. Otolaryngol Head Neck Surg. 2013;148:223–8. Preoperative assessment using fiberoptic endoscopic evaluation of swallowing demonstrated that post-swallow hypopharyngeal reflux was predictive of a diverticulum larger than 1 cm and may be useful in surgical planning.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Bloom JD, Bleier BS, Mirza N, Chalian AA, Thaler ER. Factors predicting endoscopic exposure of Zenker’s diverticulum. Ann Otol Rhinol Laryngol. 2010;119:736–41. Factors that significantly correlated with endoscopic exposure failure included a short neck, short hyomental distance and high BMI.

    PubMed  Google Scholar 

  4. Bonavina L, Bona D, Abraham M, Saino G, Abate E. Long-term results of endosurgical and open surgical approach for Zenker diverticulum. World J Gastroenterol. 2007;13:2586–9. Both endoscopic stapler and open stapled diverticulectomy groups reported good short and long-term outcomes. The authors advocate performing a longer myotomy in order to prevent recurrence. They also recommend small diverticula as a formal contraindication to endoscopic stapling.

    PubMed  Google Scholar 

  5. Chang YC, Payyapilli RJ, Scher RL. Endoscopic staple diverticulostomy for Zenker’s diverticulum: review of literature and experience in 159 consecutive cases. Laryngoscope. 2003;113:957–65. Compared to open techniques, endoscopic stapler produced shorter operative times, quicker time to PO, and lower complication and mortality rates. Compared to endoscopic laser, endoscopic stapler led to comparable operative times and mortality rates but fewer complications and more rapid convalescent times.

    Article  PubMed  Google Scholar 

  6. Ferreira LE, Simmons DT, Baron TH. Zenker’s diverticula: pathophysiology, clinical presentation, and flexible endoscopic management. Dis Esophagus. 2008;22(21):1–8. Good description of the different cutting techniques of flexible endoscopic treatment, as well as the variety of accessories that improve exposure and optimize safety.

    Google Scholar 

  7. Gutschow CA, Hamoir M, Rombaux P, Otte JB, Goncette L, Collard JM. Management of pharyngoesophageal (Zenker’s) diverticulum: which technique? Ann Thorac Surg. 2002;74:1677–83. This study demonstrated better symptomatic relief with open techniques compared to endoscopic, especially in smaller diverticula. Diverticula resection without CP myotomy predisposed to development of fistula and recurrence.

    Article  PubMed  Google Scholar 

  8. Koch M, Mantsopoulos K, Velegrakis S, et al. Endoscopic laser-assisted diverticulotomy versus open surgical approach in treatment of Zenker’s diverticulum. Laryngoscope. 2011;121:2090–4. Although the operative time, hospital stay and complication rate were significantly lower in the endoscopic laser group, the recurrence rate was significantly lower in the open group.

    Article  PubMed  Google Scholar 

  9. Mantsopoulos K, Psychogios G, Kunzel J, Zenk J, Iro H, Koch M. Evaluation of the different transcervical approaches for Zenker diverticulum. Otolaryngol Head Neck Surg. 2012;146:725–9. Hospitalization times were significantly shorter in the inversion group compared to open diverticulectomy. There was no difference in operative time, recurrence rate or follow-up satisfaction with the surgery.

    Article  PubMed  Google Scholar 

  10. Pomerri F, Costantini M, Dal Bosco C, Battaglia G, Bottin R, Zanatta L, Ancona E, Muzzio PC. Comparison of preoperative and surgical measurements of Zenker’s diverticulum. Surg Endosc. 2012;26:2010–5. This study confirms that preoperative barium radiography accurately evaluates diverticulum size compared to surgical measurements and is essential in surgical planning.

    Article  PubMed  Google Scholar 

  11. Siddiq MA, Sood S, Strachan D. Pharyngeal pouch (Zenker’s diverticulum). Postgrad Med J. 2001;77:508–11. Succinct review of epidemiology, etiology, clinical presentation and treatment options of Zenker’s diverticulum.

    Article  Google Scholar 

  12. Simic A, Radovanovic N, Stojakov D, Bjelovic M, Kotarac M, Sabljak P, Skrobic O, Pesko P. Surgical experience of the national institution in the treatment of Zenker’s diverticula. Acta Chir Iugosl. 2009;56:25–33. Compares three open approaches that were used based on diverticula size. Although hospital stay and time to oral intake were significantly longer in the resection group, good outcomes were achieved in all groups.

    Article  CAS  PubMed  Google Scholar 

  13. Veenker EA, Andersen PE, Cohen JI. Cricopharyngeal spasm and Zenker’s diverticulum. Head Neck. 2003;25:681–94. Critical evaluation of histopathologic, manometric, fluoroscopic and retrospective clinical studies of cricopharyngeal spasm and its role in Zenker’s diverticulum.

    Article  PubMed  Google Scholar 

  14. Whited C, Lee WT, Scher R. Evaluation of endoscopic harmonic diverticulostomy. Laryngoscope. 2012;122:1297–300. The largest study comparing endoscopic harmonic scalpel and stapler demonstrated a significantly higher complication rate for the harmonic scalpel.

    Article  PubMed  Google Scholar 

  15. Yuan Y, Zhao YF, Hu Y, Chen LQ. Surgical treatment of Zenker’s diverticulum. Dig Surg. 2013;30:207–18. This systematic review provides cumulative data on morbidity, mortality and complications of all open and endoscopic techniques, as well as outcomes details from selected studies.

    Article  PubMed  Google Scholar 

  16. Zaninotto G, Narne S, Costantini M, Molena D, Cutrone C, Portale G, Costantino M, Rizzetto C, Basili U, Ancona E. Tailored approach to Zenker’s diverticula. Surg Endosc. 2003;17:129–33. Both open and endoscopic groups demonstrated an UES pressure reduction, improved UES relaxation and lower intrabolus pressure on manometry, but persistent dysphagia was higher in the endoscopic group.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Section of Otolaryngology-Head and Neck Surgery, The University of Chicago Medical Center, 5841 S. Maryland Avenue, MC 1035, Chicago, IL, 60637, USA

    Cheryl C. Nocon MD & Louis D. Portugal MD

Authors
  1. Cheryl C. Nocon MD
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  2. Louis D. Portugal MD
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Corresponding author

Correspondence to Cheryl C. Nocon MD .

Editor information

Editors and Affiliations

  1. Department of Surgery, Boston Veteran Administration Healthcare System, West Roxbury, MA, USA, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA

    P. Marco Fisichella

  2. Department of Surgical Sciences, University of Torino, Torino, Italy, Division of Biological Sciences, University of Chicago, Chicago, Illinois, USA

    Marco E. Allaix

  3. Department of Surgical Sciences, University of Torino, Turin, Italy

    Mario Morino

  4. Department of Surgery, Center for Esophageal Diseases, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA

    Marco G. Patti

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© 2014 Springer International Publishing Switzerland

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Nocon, C.C., Portugal, L.D. (2014). Evaluation and Treatment of Zenker’s Diverticulum. In: Fisichella, P., Allaix, M., Morino, M., Patti, M. (eds) Esophageal Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-04337-1_9

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  • DOI: https://doi.org/10.1007/978-3-319-04337-1_9

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-04336-4

  • Online ISBN: 978-3-319-04337-1

  • eBook Packages: MedicineMedicine (R0)

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