What are the advantages and disadvantages of endoscopic diverticulotomy with stapler for the treatment of Zenker diverticulum?

Updated: Jan 23, 2018
  • Author: Joel A Ernster, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Answer

A study by Bonavina et al indicated that transoral stapling is a safe and effective treatment for Zenker diverticulum, with dysphagia and regurgitation scores significantly improving over a median follow-up period of 63 months and the median number of annual pneumonia episodes being significantly reduced. The operation, performed on 100 patients in the study, had an overall long-term success rate of 76%; the success rate was higher in patients aged 70 years or older (who tended to have larger diverticula) and in cases in which traction sutures were used on the septum. [52]

A prospective study by Van Abel et al assessed short-term quality-of-life changes and functional outcomes following transoral diverticulotomy with CP myotomy, finding improvement in both of these measures. The changes were evaluated in 18 patients at 3 months postprocedure through the Reflux Symptom Index (improvement from 27 preprocedure to 5), the Functional Outcome of Swallowing Scale (improvement from 2 preprocedure to 0), and the 10-item Eating Assessment Tool (improvement from 21.5 preprocedure to 0). [53]

Advantages of endoscopic diverticulotomy with stapler include the following:

  • Short surgical time

  • Easily repeated

  • Quick return to oral alimentation

  • Short hospitalization

  • Less tissue trauma

  • Highly effective

Disadvantages include the following:

  • Unable to perform in some patients

  • Does not remove the diverticulum

  • No tissue for pathologic review


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