Flexible endoscopy for Zenker’s diverticulum is safe, according to study

Flexible endoscopy for Zenker’s diverticulum is safe

According to researchers, flexible endoscopic treatment of Zencker’s diverticulum is effective and safe in the long-term. Zencker’s diverticulum is a disorder that occurs mostly in older patients and is manifested by difficulty in swallowing. The results of the study conducted by researchers from Belgium are published in Gastrointestinal Endoscopy journal (of the American Society for Gastrointestinal Endoscopy). Zencker’s diverticulum is an abnormal mucosal pouch located on the posterior wall of the pharyngo-esophageal junction. It is believed that what causes esophageal diverticula are related to esophageal motility, such as incomplete muscle relaxation or increased pressure inside the esophagus. This condition can be asymptomatic or can cause symptoms like regurgitation, difficulty in swallowing or chronic coughing. It is often accompanied by gastroesophageal reflux disease. Untreated, Zencker’s diverticulum can cause a number of complications such as bleeding, ulceration, diverticular perforation, infection, aspiration, pneumonia, and others.

Zenker’s diverticulum

Treatment of  Zencker’s  diverticulum consists of myotomy, that is muscle incision to release the constriction, which can be performed either by open surgery or by endoscopic approach. Obviously endoscopic treatment is preferably to open surgery due to a lower risk of complications and because of a shorter hospitalization stay. It must be mentioned that endoscopic therapy has evolved greatly in the last 20 years, and that there have been many studies showing the benefits of using flexible compared to the rigid endoscope.

A previous study showed that diverticulotomy with flexible endoscope and soft diverticuloscope is a safe and effective treatment for treating Zencker’s diverticulum. Lead author Jacques Devi, MD, PhD, Hôpital Erasme, Brussels, Belgium, said that this first study led them to improve the technique and add endoclips in order to reduce the risk of perforation and bleeding.

Researchers performed a retrospective study that included 150 patients who were treated between 2002 and 2011 in the Hôpital Erasme, Brussels, Belgium. Patients with Zencker’s diverticulum were treated by endoscopic approach and after the treatment, patients were re-evaluated at one month and at the end of follow-up. Study results showed that all patients had successful endoscopic treatment and a median hospital stay of one day. There were only 4 cases of adverse reactions and all these were treated conservatively.

Dysphagia score decreased from 1.88 to 0.29 and 0.34 at the end of follow-up (0 means no dysphagia and 4 means complete dysphagia). Chronic cough and regurgitation decreased significantly from 73% and 27% to 11% and 2% at the end of follow-up, respectively. The conclusion of the investigators was that flexible endoscopy has become the new standard for the treatment Zencker’s diverticulum.