Summary of the four articles on Zenker's diverticulum endotherapy

Thomas Rösch

Treatment of Zenker’s diverticulum by flexible endoscopy consists of splitting the bridge between the diverticulum and the proximal esophagus, using different methods (needle-knife cutting, argon plasma coagulation, or coagulation forceps). Generally an esophageal feeding tube is used to help to keep the contralateral esophageal wall at a distance and a mucosectomy cap to provide a better view and stability of the operating field, or - most recently - an overtube with a distal rim which rides on the septum has been employed. All these techniques are reported in four uncontrolled studies in this issue of Endoscopy; complications were mostly minor and no patient had to undergo emergency surgery. Cervical emphysema does, however, occur: a word of caution that this eventuality must be taken seriously is certainly justified. Clinical recurrence occurs in around 20 % of cases and can mostly be treated again. It remains for future comparative trials to show which technique is the best and how recurrence can be avoided. In an accompanying Editorial (p. 154), the articles are discussed from the surgical perspective.

Overwiew of results on Zenker9s diverticulum endotherapy presented in this issue of Endoscopy Authors Patients, n Technique Initial sessions, n Success Follow-up, months Recurrence Complications Initial Long-term Vogelsang et al. (p. 131) 31 Needle-knife 1 100 % 84 % 26 32 % 23 % Christiaens et al. (p. 137) 21 Monopolar forceps 1 100 % 100 % 23 10 % 5 % Rabenstein et al. (p. 141) 41 (30)* Argon beamer 3 95 % 95 % 16* 17 % 20 % Costamagna et al. (p. 146) 39 Needle-knife 11 with DIV(clips) 1 - 43 %† 36, 6† - 23 % DIV, diverticuloscope (special overtube).* 41 patients treated, 11 recently, follow-up for 30 cases.† Success was 82 % (n = 11, follow-up 6.5 months) with DIV, and only 29 % (n = 28, follow-up 36 months) with the cap technique.

Thomas Rösch

Editor-in-Chief