Acta Endoscopica

, Volume 43, Issue 3, pp 105–108 | Cite as

Traitement endoscopique du diverticule de Zenker

Revue de Congrès / Congress Review

Résumé

Le diverticule de Zenker est une protrusion muqueuse au travers du triangle de Killian liée à un défaut du muscle cricopharyngien. Le traitement chirurgical de référence comprenant la diverticulectomie et la section du muscle cricopharyngien par voie cervicale tend à être remplacé par le traitement endoscopique rigide ou souple. Le traitement par voie endoscopique repose sur la section de la paroi entre diverticule et oesophage, et du muscle cricopharyngien qu’elle contient. Pour l’endoscopie souple, l’exposition de cette paroi est au mieux obtenue à l’aide d’un diverticuloscope souple. La section se fait à l’aide de couteaux endoscopiques et doit être limitée à la section du cricopharyngien ou par le fond du diverticule. La résolution des symptômes est obtenue le plus souvent en une séance de traitement au prix d’une morbidité très faible. La réalimentation se fait habituellement dans les 12 à 24 heures. L’infection, et en particulier son extension vers le médiastin, est la complication la plus redoutée. L’utilisation d’un insufflateur à CO2 et de clips endoscopiques pourrait éviter une partie des complications.

Mots clés

Diverticule de Zenker Muscle cricopharyngien Diverticuloscope Diverticulotomie Perforation 

Endoscopic treatment of Zenker’s diverticulum

Abstract

Zenker’s diverticulum is an outpouching of the mucosa through the Killian’s triangle due to a default of the cricopharyngeal muscle. The reference surgical treatment including diverticulectomy and section of the cricopharyngeal muscle tends to be replaced by rigid or flexible endoscopic treatment. Endoscopic treatment consists in the section of the wall between the diverticulum and the esophagus, and of the cricopharyngeal muscle in it. For flexible endoscopy, exposure of this wall is best obtained with the help of a flexible diverticuloscope. The section is done with the help of endoscopic knives and must be limited to the section of the cricopharyngeal muscle or by the diverticulum’s bottom. Symptoms resolution is usually obtained in one treatment session with a very low morbidity. Food intakes can usually restart within 12–24 hours. Infection, and particularly its extent to the mediastinum, is the most feared complication. Using CO2 insufflation and endoscopic clips could help avoiding part of the complications.

Keywords

Zenker’s diverticulum Cricopharyngeal muscle Diverticuloscope Diverticulotomy Perforation 

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Copyright information

© Springer-Verlag France 2013

Authors and Affiliations

  1. 1.Centre hospitalier Princesse-GraceMonacoFrance

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