Significant symptomatic relief after transoral endoscopic staple-assisted treatment of Zenker's diverticulum

Abstract

Background: Zenker's diverticulum is associated with characteristic symptoms of progressive dysphagia and regurgitation. As most patients are elderly, the perioperative risk is usually high. We report our clinical experience with the transoral endoscopic staple-assisted method, including a thorough assessment of the symptomatic relief achieved by the procedure. Methods: 46 consecutive patients (29 m, 17 f) with a median age of 61 years (range, 37–96 years) were treated between 1997 and 2002. The symptoms and their frequency were registered. The follow-up consisted of clinical and radiographic investigations. Results: The median size of the diverticulum was 4 cm (range, 2–12 cm). Transoral treatment was successful in 39 patients; in 7 cases (15.2%) a switch to open surgery was required. The median operating time was 30 min (range, 10–150 min). Mortality rate was nil, while morbidity was 7.7%. The median duration of the postoperative hospital stay was 5 days (range, 1–65 days). After a median follow-up of 11 months (range, 1–40 months), 5 patients had been reoperated on endoscopically due to clinical recurrence. Clinical symptoms were significantly reduced (dysphagia of liquids p ? 0.0001, dysphagia of solids p ? 0.001, regurgitation p ? 0.001). Conclusion: Our results confirm that minimal invasive treatment of Zenker's diverticulum is a safe method and provides significant symptomatic relief.