Subscribe to RSS
Practice patterns, techniques, and outcomes of flexible endoscopic myotomy for Zenker’s diverticulum: a retrospective multicenter study
Background Flexible endoscopic myotomy has been increasingly performed for Zenker’s diverticulum using various endoscopic techniques and devices. The main aims of this study were to assess practice patterns and compare outcomes of endoscopic myotomy for Zenker’s diverticulum.
Methods Procedures performed at 12 tertiary endoscopy centers from 1/2012 to 12/2018 were reviewed. Patients (≥ 18 years) with Zenker’s diverticulum who had dysphagia and/or regurgitation and underwent endoscopic myotomy were included. Outcomes assessed included technical success, clinical success, and adverse events.
Results 161 patients were included. Traditional endoscopic septotomy was performed most frequently (137/161, 85.1 %) followed by submucosal dissection of the septum and myotomy (24/161, 14.9 %). The hook knife (43/161, 26.7 %) and needle-knife (33/161, 20.5 %) were used most frequently. Overall, technical and clinical success rates were 98.1 % (158/161) and 78.1 % (96/123), respectively. Adverse events were noted in 13 patients (8.1 %). There was no significant difference in technical and clinical success between traditional septotomy and submucosal dissection groups (97.1 % vs. 95.8 %, P = 0.56 and 75.2 % vs. 90.9 %, P = 0.16, respectively). Clinical success was higher with the hook knife (96.7 %) compared with the needle-knife (76.6 %) and insulated tip knife (47.1 %). Outcomes were similar between centers performing > 20, 11 – 20, and ≤ 10 procedures.
Conclusions Flexible endoscopic myotomy is an effective therapy for Zenker’s diverticulum, with a low rate of adverse events. There was no significant difference in outcomes between traditional septotomy and a submucosal dissection approach, or with centers with higher volume, though clinical success was higher with the hook knife.
Received: 26 March 2020
Accepted: 14 July 2020
14 July 2020 (online)
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Siddiq MA, Sood S, Strachan D. Pharyngeal pouch (Zenker’s diverticulum). Postgrad Med J 2001; 77: 506-511
- 2 Siddiq MA, Sood S. Current management in pharyngeal pouch surgery by UK otorhinolaryngologists. Ann R Coll Surg Engl 2004; 86: 247-252
- 3 Klockars T, Sihvo E, Makitie A. Familial Zenker’s diverticulum. Acta Otolaryngol 2008; 128: 1034-1036
- 4 Feeley MA, Righi PD, Weisberger EC. et al. Zenker’s diverticulum: analysis of surgical complications from diverticulectomy and cricopharyngeal myotomy. Laryngoscope 1999; 109: 858-861
- 5 Payne WS. The treatment of pharyngoesophageal diverticulum: the simple and complex. Hepatogastroenterology 1992; 39: 109-114
- 6 Ishioka S, Sakai P, Maluf Filho F. et al. Endoscopic incision of Zenker's diverticula. Endoscopy 1995; 27: 433-437
- 7 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
- 8 Eckardt VF. Clinical presentations and complications of achalasia. Gastrointest Endosc Clin N Am 2001; 11: 281-292
- 9 Kedia P, Fukami N, Kumta NA. et al. A novel method to perform endoscopic myotomy for Zenker’s diverticulum using submucosal dissection techniques. Endoscopy 2014; 46: 1119-1121
- 10 Ishaq S, Hassan C, Antonello A. et al. Flexible endoscopic treatment for Zenker’s diverticulum: a systematic review and meta-analysis. Gastrointest Endosc 2016; 83: 1076-1089.e5
- 11 Balassone V, Pizzicannella M, Biasutto D. et al. Submucosal per-oral endoscopic myotomy for a large Zenker’s diverticulum with use of a hydrodissector knife and an over-the-scope clip closure. VideoGIE 2018; 3: 373-374
- 12 Bahsi S, Rustemova N, Vosoughi K. et al. Zenker’s diverticulum peroral endoscopic myotomy using a scissors-type knife. Endoscopy 2019; 51: E231-E232
- 13 Syed A, Kaul V, Thakkar S. Endoscopic myotomy of Zenker’s diverticulum using a novel electrosurgical knife: first reported case in the USA. Dig Endosc 2019; 31: e22-e3
- 14 Repici A, Pagano N, Romeo F. et al. Endoscopic flexible treatment of Zenker’s diverticulum: a modification of the needle-knife technique. Endoscopy 2010; 42: 532-535
- 15 Rouquette O, Abergel A, Mulliez A. et al. Usefulness of the Hook knife in flexible endoscopic myotomy for Zenker’s diverticulum. World J Gastrointest Endosc 2017; 9: 411-416
- 16 Goelder SK, Brueckner J, Messmann H. Endoscopic treatment of Zenker’s diverticulum with the stag beetle knife (sb knife) – feasibility and follow-up. Scand J Gastroenterol 2016; 51: 1155-1158
- 17 Battaglia G, Antonello A, Realdon S. et al. Flexible endoscopic treatment for Zenker’s diverticulum with the SB Knife. Preliminary results from a single-center experience. Dig Endosc 2015; 27: 728-733
- 18 Gonzalez N, Debenedetti D, Taullard A. Endoscopic retreatment of Zenker’s diverticulum using novel endoscopic scissors – the Clutch Cutter device. Rev Esp Enferm Dig 2017; 109: 669
- 19 Pang M, Koop A, Brahmbhatt B. et al. Comparison of flexible endoscopic cricopharyngeal myectomy and myotomy approaches for Zenker diverticulum repair. Gastrointest Endosc 2019; 89: 880-886
- 20 Yang J, Novak S, Ujiki M. et al. An international study on the use of peroral endoscopic myotomy in the management of Zenker’s diverticulum. Gastrointest Endosc 2020; 91: 163-168