Is an endoscopic or external diverticulectomy more effective for treatment of Zenker’s diverticulum?
Background: Although the incidence of Zenker’s diverticulum (ZD) in the general population is low (0.01% to 0.11%), it can have significant impact on an individual’s quality of life and can lead to pneumonias and chronic cough. There are two approaches to treatment of the condition: endoscopic (END) and external (EXT). This study sought to compare these two procedures in terms of in-hospital parameters, complications, return to normal diet, and rates of symptom recurrence.
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January 2015Study design: Retrospective, single-institution chart review of 67 patients over a 12-year period.
Setting: Brigham and Women’s Hospital, Boston.
Synopsis: Pre-operative symptoms and demographic variables were similar between the two groups. Thirty-six patients underwent the END approach using either a stapler or CO2 laser, and 31 underwent the EXT stapler-assisted diverticulectomy with cricopharyngeal myotomy. In the END technique, visualization of the cricopharyngeus and the pouch was followed by a stapler-assisted or CO2 laser-assisted myotomy. In the EXT approach, the esophagus was intubated and the ZD was packed. The median END operative time was significantly shorter (53 min END versus 152 min EXT).
There was a nonsignificantly higher rate of complications in the END group than in the EXT group. There was no difference in the length of hospital stay or time to oral intake. The rate of recurrence was significantly higher in the END group at 39% (13 patients), compared with no recurrences in the external group (P = .00011). One of the reasons for this may be the dead space at the end of the endoscopic stapler, which makes it more difficult to perform a complete myotomy.
Bottom line: The external approach is superior to the endoscopic approach when considering the much lower rate of symptomatic recurrence and need for revision procedures in the former.
Reviewed by Natasha Mirza, MD