CAP-ASSISTED ENDOSCOPIC SEPTOTOMY OF ZENKER DIVERTICULUM (ZD): EARLY AND LONG-TERM OUTCOME

Aims Minimally invasive flexible endoscopic septotomy (FES) techniques to manage ZD have been increasingly favored over the past 20 years even though long-term outcome data are scanty.

Methods From January 2010 to December 2017, naïve patients treated with FES were identified. Endoscopic procedures were performed with a flexible endoscope with a cap and a single incision septotomy using Hook Knife. Eight hours after the procedure, patients resumed clear liquid diet that was maintained for 24 hours with a subsequent gradual transition to a regular diet over 3 days. Data collected and analyzed included patient, diverticulum and endoscopic technique items as well as early and long-term outcome. Dakkak and Bennett dysphagia scale was used to rate the dysphagia. Persistent complete or near-complete resolution of symptoms was defined as clinical success. Postprocedural complications have been reported according to ASGE lexicon. Recurrence was defined as symptoms reappearance with endoscopic or fluoroscopic evidence of residual diverticular septum.

Results Overall 256 consecutive naïve patients were treated. The procedure was successfully completed in all scheduled patients, with an average operational time of 18.5 minutes. 92.2% of the cases was performed under deep sedation. Patients were treated in 52.3% of cases in outpatient regimen with an average hospitalization time of 1.6 days. Early clinical success was observed in 96.1%. Complications occurred in 3.5% (9/256) of patients and in 77.8% (7/9) were moderate with no fatal event. Only patient required surgical approach to manage the complication. Recurrence occurred in 31.3% (80/256) of treated patients after median time of 9 months (5.5-24) and all recurrences were successfully retreated by FES. At an average follow-up of 5.5 years, 95.1% of patients were asymptomatic.

Conclusions Early and long-term results confirm that cap-assisted with hook-knife FES is a safe and effective treatment modality for patients with ZD.