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Management of the Zenker diverticulum: multicenter retrospective comparative study of open surgery and rigid endoscopy versus flexible endoscopy

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Abstract

Background and study aim

Zenker’s diverticulum is a rare disease that affects quality of life due to dysphagia and regurgitation. This condition can be treated by various surgical or endoscopic methods.

Patients and method

Patients treated for Zenker’s diverticulum in three centers in the south of France between 2014 and 2019 were included. The primary objective was clinical efficacy. Secondary objectives were technical success, morbidities, recurrences, and need for a new procedure.

Results

One hundred forty-four patients with a total of one hundred sixty-five procedures performed were included. A significant difference was found between the different groups in terms of clinical success (97% for open surgery versus 79% for rigid endoscopy versus 90% for flexible endoscopy, p = 0.009). Technical failure occurred more frequently in the rigid endoscopy group than in the flexible endoscopy and surgical groups (p = 0.014). Median procedure duration, median time to resumption of feeding, and hospital discharge were statistically shorter for endoscopies than for open surgery. On the other hand, more recurrences occurred in patients treated by endoscopy than those treated by surgery, and more reinterventions were required.

Conclusion

Flexible endoscopy appears to be as effective and safe as open surgery in the treatment of Zenker’s diverticulum. Endoscopy allows a shorter hospital stay at the expense of a higher risk of recurrence of symptoms. It could be used as an alternative to open surgery for the treatment of Zenker’s diverticulum, especially in frail patients.

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Authors and Affiliations

  1. Gastroenterology Department, CHU Montpellier, Montpellier, France

    Franz Rudler, Guillaume Pineton de Chambrun, Jean-Christophe Valats & Pierre Blanc

  2. ORL Department, CHU Nimes, Nîmes, France

    Benjamin Lallemant & Christophe Reynaud

  3. ORL Department, CHU Montpellier, Montpellier, France

    Renaud Garrel

  4. Gastroenterology Department, CHU Nimes, Nimes, France

    Philippe Pouderoux & Ludovic Caillo

  5. Gastroenterology Department, CH Beziers, Béziers, France

    Mohamed Ramdani

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  1. Franz Rudler
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  2. Guillaume Pineton de Chambrun
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  3. Benjamin Lallemant
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  4. Renaud Garrel
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  5. Philippe Pouderoux
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  7. Ludovic Caillo
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  8. Christophe Reynaud
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  9. Jean-Christophe Valats
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Correspondence to Franz Rudler.

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Franz Rudler, Guillaume Pineton de Chambrun, Benjamin Lallemant, Philippe Pouderoux, Mohamed Ramdani, Ludovic Caillo, Christophe Reynaud, Jean-Christophe Valats, Pierre Blanc have no conflicts of interest or financial ties to disclose.

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Rudler, F., Pineton de Chambrun, G., Lallemant, B. et al. Management of the Zenker diverticulum: multicenter retrospective comparative study of open surgery and rigid endoscopy versus flexible endoscopy. Surg Endosc 37, 7064–7072 (2023). https://doi.org/10.1007/s00464-023-10225-4

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  • DOI: https://doi.org/10.1007/s00464-023-10225-4

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