Abstract
Background
Symptomatic Zenker’s diverticulum (ZD) occurs mostly in the elderly, who often have significant comorbidities, and poor neck hyperextension, putting them at high risk for surgical management while also increasing the potential of technical failure. Flexible endoscopic incisional therapy for Zenker’s diverticulum (FEIT-Z) offers a safe approach to this problem with high technical and clinical success rates. There are limited data on its use following a failed surgical approach or in patients unfit for a surgical approach. The aim of this study was to assess clinical and technical outcomes of FEIT-Z in patients who were non-operative candidates or refused or failed surgical management.
Methods
Patients who underwent FEIT-Z from January 2015 to February 2019 at a tertiary referral center were included. Patient demographics, prior ZD surgical history, procedural data, dysphagia scores, clinical success, and adverse events (AE) were collected. Univariable analysis was performed to assess differences between pre- and post-FEIT-Z dysphagia scores.
Results
30 patients undergoing FEIT-Z were included. Seven had a prior failed ZD surgical approach, 6 refused surgical management, and 17 were deemed to be non-operative candidates based on medical comorbidities. Mean age was 78.4 (± 12.1) and 36.7% were male. Technical success of FEIT-Z was 96.7%. There was a significant improvement in dysphagia scores after FEIT-Z: 2.3 (± 0.64) vs. before, 0.4 (± 0.76) (p < 0.001). Long-term clinical success was achieved in 73.3% of patients. Adverse events were seen in 23.3% of patients; however, these were graded as mild in 85.7% of patients. One microperforation was managed with antibiotics.
Conclusion
FEIT-Z is a safe procedure with low adverse events and a high rate of technical and clinical success. FEIT-Z can be done in patients who fail previous surgical treatment, refuse a surgical approach, or are not surgical candidates due to medical comorbidity or other factors.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Belsey R (1966) Functional disease of the esophagus. J Thorac Cardiovasc Surg 52:164–188
Ferguson MK (1991) Evolution of therapy for pharyngoesophageal (Zenker’s) diverticulum. Ann Thorac Surg 51:848–852
Siddiq MA, Sood S, Strachan D (2001) Pharyngeal pouch (Zenker’s diverticulum). Postgrad Med J 77:506–511
Costantini M, Zaninotto G, Rizzetto C, Narne S, Ancona E (2004) Oesophageal diverticula. Best Pract Res Clin Gastroenterol 18:3–17
Zaninotto G, Narne S, Costantini M, Molena D, Cutrone C, Portale G, Constantino M, Rizzetto C, Basili U, Ancona E (2003) Tailored approach to Zenker’s diverticula. Surg Endosc 17:129–133
Crescenzo DG, Trastek VF, Allen MS, Deschamps C, Pairolero PC (1998) Zenker’s diverticulum in the elderly: is operation justified? Ann Thorac Surg 66:347–350
Mittal C, Diehl D, Draganov P, Jamil L, Khalid A, Khara H, Khullar V, Law R, Lo S, Mathew A, Mirakhor E (2021) Practice patterns, techniques, and outcomes of flexible endoscopic myotomy for Zenker’s diverticulum: retrospective, multi-center study. Endoscopy 53:346–353
Jain D, Sharma A, Shah M, Patel U, Thosani N, Singhal S (2018) Efficacy and safety of flexible endoscopic management of Zenker’s diverticulum. J Clin Gastroenterol 52:369–385
Ishaq S, Hassan C, Antonello A, Tanner K, Bellisario BG, Anderlone A, Correale L, Sharma P, Baron TH, Repici A (2016) Flexible endoscopic treatment for Zenker’s diverticulum: a systematic review and meta-analysis. Gastrointest Endosc 83:1076–1089
Mellow MH, Pinkas H (1984) Endoscopic therapy for esophageal carcinoma with Nd:YAG laser: prospective evaluation of efficacy, complications, and survival. Gastrointest Endosc 30:334–9
Cotton PB, Eisen GM, Aabakken L, Baron TH, Hutter MM, Jacobson BC, Mergener K, Nemcek A, Petersen BT, Petrini JL, Pike IM (2010) A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 71:446–454
Safdar A, Curran A, Timon CV (2004) Endoscopic stapling vs conventional methods of surgery for pharyngeal pouches: results, benefits and modifications. Ir Med J 97:75–76
Adam SI, Paskhover B, Sasaki CT (2013) Revision Zenker diverticulum: laser versus stapler outcomes following initial endoscopic failure. Ann Otol Rhinol Laryngol 122:247–253
Oestreicher-Kedem Y, Wasserzug O, Sagi B, Carmel NN, Zikk D (2016) Revision endoscopic stapler Zenker’s diverticulotomy. Surg Endosc 30:2022–2025
Dhar SI, Wegner AM, Rodnoi P, Wuellner JC, Mehdizadeh OB, Shen SC, Nachalon Y, Nativ-Zeltzer N, Klineberg EO, Belafsky PC (2020) Swallowing characteristics in Zenker’s-like diverticulum after anterior cervical spine surgery. Laryngoscope 130:1383–1387
Vogelsang A, Preiss C, Neuhaus H, Schumacher B (2007) Endotherapy of Zenker’s diverticulum using the needle-knife technique: long-term follow-up. Endoscopy 39:131–136
Brueckner J, Schneider A, Messmann H, Golder SK (2016) Long-term symptomatic control of Zenker diverticulum by flexible endoscopic mucomyotomy with the hook knife and predisposing factors for clinical recurrence. Scand J Gastroenterol 51:666–671
Pescarus R, Shlomovitz E, Sharata AM, Cassera MA, Reavis KM, Dunst CM, Swanström LL (2016) Trans-oral cricomyotomy using a flexible endoscope: technique and clinical outcomes. Surg Endosc 30:1784–1789
Antonello A, Ishaq S, Zanatta L, Cesarotto M, Costantini M, Battaglia G (2016) The role of flexible endotherapy for the treatment of recurrent Zenker’s diverticula after surgery and endoscopic stapling. Surg Endosc 30:2351–2357
Yuan Y, Zhao YF, Hu Y, Chen LQ (2013) Surgical treatment of Zenker’s diverticulum. Dig Surg 30:207–218
Funding
No funding.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
David L. Diehl, MD and Harshit Khara, MD are consultants for Olympus Corporation of America. Minesh J. Mehta, MD, Ammara Khalid, MD, Muhammad A. Shafqet, MD, and Bradley Confer do not have conflicts of interest or financial ties to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Diehl, D.L., Mehta, M.J., Khalid, A. et al. Flexible endoscopic incisional therapy for Zenker’s diverticulum (FEIT-Z) is an effective treatment for surgical failures or non-operative patients. Surg Endosc 36, 8863–8868 (2022). https://doi.org/10.1007/s00464-022-09318-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-022-09318-3