Techniques and efficacy of flexible endoscopic therapy ofZenker＇s diverticulum
摘要
Zenker＇s diverticulum （ZD） is an abnormal hypopharyngealpouch often presenting with dysphagia. Treatment isoften sought with invasive surgical management of thediverticulum being the only mode of definitive therapy.Primarily done by an open transcervical approachin the past, nowadays treatment is usually providedby otolaryngologists using a less invasive trans-oraltechnique with a rigid endoscope. When first described,this method grew into acceptance quickly due to itssimilar efficacy and vastly improved safety profilecompared to the open transcervical approach. However,the main limitation with this approach is that it may notbe suitable for all patients. Nonetheless, progress inthe field of natural orifice endoscopic surgery over thelast 10-20 years has led to the increase in utilization ofthe flexible endoscope in the treatment of ZD. Primarilyperformed by interventional gastroenterologists, thisapproach overcomes the prior limitation of its surgicalcounterpart and allows adequate visualization of thediverticulum independent of the patient＇s body habitus.Additionally, it may be performed without the useof general anesthesia and in an outpatient setting,thus further increasing the utility of this modality,especially in elderly patients with other comorbidities.Today, results in more than 600 patients have beendescribed in various published case series usingdifferent techniques and devices demonstrating a highpercentage of clinical symptom resolution with lowrates of adverse events. In this article, we present ourexperience with flexible endoscopic therapy of Zenker＇sdiverticulum and highlight the endoscopic technique,outcomes and adverse events related to this minimallyinvasive modality.