Ösophagusdivertikel

Zusammenfassung

Ösophagusdivertikel sind eine relevante Differenzialdiagnose bei Dysphagie. Je nach Lage des Divertikels und Pathogenese gibt es unterschiedliche therapeutische Ansätze. Während früher die Therapie rein chirurgisch erfolgte, spielt insbesondere beim Zenker-Divertikel zunehmend die flexible Endoskopie eine wichtige Rolle. In dieser Übersichtsarbeit werden die häufigsten Divertikelformen vorgestellt und wesentliche Informationen zu Pathogenese, Diagnostik und Therapie vermittelt. Dabei werden insbesondere Vor- und Nachteile der chirurgischen und endoskopischen Therapieformen diskutiert.

Abstract

Esophageal diverticula are a relevant cause of dysphagia. Depending on the location of the diverticulum and its etiology different therapeutic options exist. Surgical therapies have been the standard, but especially for Zenker‘s diverticulum flexible endoscopy plays an increasing role. In this review the different types of diverticula and important information concerning pathogenesis, diagnostics and therapy are discussed. The focus lies on the advantages and disadvantages of surgical and endoscopic therapy.

• Literatur

• 1 Zenker FA, von Ziemssen H. Krankheiten des Ösophagus. In: von Ziemssen H, (ed.) Handbuch der speziellen Pathologie und Therapie. Vol. 7. (Suppl) Leipzig: FCW Vogel; 1877: 1-87
• 2 Siddiq MA, Sood S, Strachan D. Pharyngeal pouch (Zenker's diverticulum). Postgrad Med J 2001; 77 (910) 506
• 3 Ferreira LE, Simmons DT, Baron TH. Zenker's diverticula: pathophysiology, clinical presentation, and flexible endoscopic management. Dis Esophagus 2008; 21 (01) 1-8
• 4 Fulp SR, Castell DO. Manometric aspects of Zenker's diverticulum. Hepatogastroenterology 1992; 39 (02) 123
• 5 Herbella FA, Dubecz A, Patti MG. Esophageal diverticula and cancer. Dis Esophagus 2012; 25 (02) 153-158
• 6 Achem SR, Devault KR. Dysphagia in aging. J Clin Gastroenterol 2005; 39 (05) 357-371
• 7 Vogelsang A, Schumacher B, Neuhaus H. Therapy of Zenker’s diverticulum. Dtsch Arztebl 2008; 105 (07) 120-126
• 8 Sen P, Bhattacharyya MS. Endoscopic stapling of pharyngeal pouch. J Laryngol Otol 2004; 118: 601-606
• 9 Seth R, Rajasekaran K, Lee WT et al. Patient reported outcomes in endoscopic and open transcervical treatment for Zenker's diverticulum. Laryngoscope 2014; 124 (01) 119-125
• 10 Rabenstein T, May A, Michel J et al. Argon plasma coagulation for flexible endoscopic Zenker's diverticulotomy. Endoscopy 2007; 39 (02) 141-145
• 11 Vogelsang A, Preiss C, Neuhaus H et al. Endotherapy of Zenker's diverticulum using the needle-knife technique: long-term follow-up. Endoscopy 2007; 39 (02) 131-136 ; Epub 2006 Oct 16
• 12 Christiaens P, De Roock W, Van Olmen A et al. Treatment of Zenker's diverticulum through a flexible endoscope with a transparent oblique-end hood attached to the tip and a monopolar forceps. Endoscopy 2007; 39 (02) 137-140
• 13 Costamagna G, Iacopini F, Tringali A et al. Flexible endoscopic Zenker's diverticulotomy: cap-assisted technique vs. diverticuloscope-assisted technique. Endoscopy 2007; 39 (02) 146-152
• 14 Huberty V, El Bacha S, Blero D et al. Endoscopic treatment for Zenker's diverticulum: long-term results (with video). Gastrointest Endosc 2013; 77 (05) 701-707
• 15 Melman L, Quinlan J, Robertson B et al. Esophageal manometric characteristics and outcomes for laparoscopic esophageal diverticulectomy, myotomy, and partial fundoplication for epiphrenic diverticula. Surg Endosc 2009; 23 (06) 1337-134 ; Epub 2008 Sep 24
• 16 Soares R, Herbella FA, Prachand VN et al. Epiphrenic diverticulum of the esophagus. From pathophysiology to treatment. J Gastrointest Surg 2010; 14 (12) 2009-2015 ; Epub 2010 May 1
• 17 Fasano NC, Levine MS, Rubesin SE et al. Epiphrenic diverticulum: clinical and radiographic findings in 27 patients. Dysphagia 2003; 18 (01) 9-15
• 18 Zaninotto G, Portale G, Costantini M et al. Long-term outcome of operated and unoperated epiphrenic diverticula. J Gastrointest Surg 2008; 12 (09) 1485-1490
• 19 Klaus A, Hinder RA, Swain J et al. Management of epiphrenic diverticula. J Gastrointest Surg 2003; 7 (07) 906-911
• 20 Aiolfi A, Bona D, Bonavina L. Endoscopic treatment of an epiphrenic diverticulum using a fully covered self-expanding metal stent. Endoscopy 2013; 45 (Suppl. 02) UCTN: E101
• 21 Hahne M, Schilling D, Arnold JC et al. Esophageal intramural pseudodiverticulosis: review of symptoms including upper gastrointestinal bleeding. J Clin Gastroenterol 2001; 33 (05) 378-382
• 22 Bechtler M, Schorr F, Hartmann D et al. Langzeitergebnisse nach Bougierung des Ösophagus bei intramuraler Pseudodivertikulose. Z Gastroenterol 2010; 48: P061