FLEXIBLE ENDOSCOPIC TREATMENT FOR ZENKER’S DIVERTICULUM: RESULTS OF OUR 44 CONVENTIONAL INTERVENTIONS

Aims Flexible endoscopic myotomy (FEM) of the cricopharyngeal muscle is a widely used technique in the treatment of symptomatic Zenker’s diverticulum. It is considered to be safe and effective. Nowadays a new endoscopic technique using submucosal tunneling method (Z-POEM) has been introduced. Until now, no clear advantage of this new technique has been confirmed.

Methods We retrospectively analyzed our experiences with conventional FEM.

Results 35 patients with symptomatic Zenker’s diverticulum were treated with FEM and 44 myotomies were performed from September 2012 until November 2019. Most of our patients were male (20/35), with average age of 72.1 (40-88) years. The mean size of diverticula was 4 (2-10) cm. We have used diverticuloscope, while free-hand technique was needed in 8 cases where positioning of the diverticuloscope could not be achieved due to anatomical reasons.

34 patients were followed (mean 15 months), one patient was lost to follow-up. Clinical success at 1 month was 91.1% (31/34). 3 patients remained symptomatic, one of them was treated with re-myotomy and became symptom-free, another two patients refused further interventions. Over the long term period, 25/31 patients remained symptom-free after one myotomy. 5/31 patients required one further myotomy and one patient had to undergo 2 more sessions of myotomies due to recurrence of symptoms. The overall clinical success was 91.1% (31/34).

We observed pneumomediastinum in one patient that was treated conservatively successfully. Intraprocedural bleeding has occurred in (5/44) cases, in all of them the bleeding was successfully stopped during intervention. In one of them, early recurrent massive bleeding required surgery. The overall rate of significant complications was 4.5% (2/44), and there was no procedure-related mortality.

Conclusions Based on our experience, conventional cricopharyngeal myotomy with flexible endoscopy is safe and effective for the treatment of Zenker’s diverticulum that does not need special expertise in the field of submucosal tunneling technique.