What are the reported outcomes 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

Immediate symptom relief occurs in 94-100% of patients.

Long-term symptom recurrence

The long-term symptom recurrence rate for patients who undergo endoscopic diverticulotomy with stapler is 0-47%. According to Gutschow, the recurrence rate with any endoscopic approach is greater if the sac is smaller. [33]

Recurrences may be successfully managed with a repeat endoscopic procedure or by using an open approach. When performing the open approach, the surgeon needs to recognize the altered anatomy present as a result of the prior endoscopic procedure.

Morbidity and mortality

The mortality rate for this procedure is 0-1%. Morbidity, which occurs in 10-31% of patients, includes the following:

  • RLN paresis/paralysis

  • Bleeding

  • Mediastinitis

  • Dental injury

  • Esophageal perforation

  • Diverticulum perforation - This can occur when placing the angled end of the stapler in a small to moderate-sized sac while it is stretched tautly by the Weerda diverticuloscope; repairing this perforation with endoscopically placed sutures has been reported, but open drainage remains the preferred approach

  • Cervical emphysema


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