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The role of flexible endotherapy for the treatment of recurrent Zenker’s diverticula after surgery and endoscopic stapling

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Abstract

Background

Currently there are three main treatment options for Zenker’s diverticulum (ZD): surgery, rigid endoscopy and flexible endoscopy. After primary success, recurrence can be as high as 19 % for surgery, 12.8 % for rigid endoscopy and 20 % for flexible endoscopy. Flexible endoscopy may represent an ideal treatment option for recurring ZD. The aims of this paper are to evaluate the efficacy and safety of flexible endotherapy for recurring ZD after surgery and/or endoscopic stapling and to compare the treatment outcome between naive and recurring patients.

Methods

Data on patients that underwent flexible endotherapy for ZD between January 2010 and January 2015 were collected. Patients were divided into those with recurrences after surgery and/or endoscopic stapling and those who did not have previous treatments. Dysphagia, regurgitation, and respiratory symptom severity before the procedure were graded. The outcome parameters were: complications, symptom improvement after the first treatment, number of treatment sessions, rate of complete remission and relapses. These parameters were then compared between patients groups.

Results

Twenty-five recurring patients were included. Treatment was carried out successfully in all patients. Two adverse events occurred; they were successfully managed conservatively. After the first treatment, there was a significant reduction in dysphagia, regurgitation and respiratory symptoms scores. The median number of treatments was 1 (IQR 0.25, range 1–3): symptom remission was achieved in 84 % patients and partial improvement in 16 %. Relapsing symptoms occurred in 20 % patients; they were successfully managed with an additional treatment session. Results were compared with data on 34 consecutive naive patients treated within the same time span; no differences of the outcome parameters were revealed.

Conclusions

Flexible endotherapy for ZD recurrences after surgery and endoscopic stapling appears to be safe and effective, and its efficacy and safety profile seems to be comparable between recurring and naive patients.

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Authors and Affiliations

  1. Digestive Endoscopy Unit, Veneto Institute of Oncology IOV – I.R.C.S.S., Padua, Italy

    Alessandro Antonello, Martina Cesarotto & Giorgio Battaglia

  2. Department of Gastroenterology, Birmingham City University, Dudley Group Hospitals, Dudley, DY1 2HQ, UK

    Sauid Ishaq

  3. Department of Medicine, St. George’s University, St. George, Grenada

    Sauid Ishaq

  4. Department of Surgery, Santa Maria Del Prato Hospital, Feltre, Italy

    Lisa Zanatta

  5. Department of Surgery, University of Padua, Padua, Italy

    Mario Costantini

Authors
  1. Alessandro Antonello
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  2. Sauid Ishaq
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  3. Lisa Zanatta
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  4. Martina Cesarotto
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  5. Mario Costantini
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  6. Giorgio Battaglia
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Corresponding author

Correspondence to Sauid Ishaq.

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Disclosures

Author G. Battaglia received 10 SB knives by Sumitomo-Bakelite Ltd. (Tokyo, Japan) as a free trial sample. Other Authors (A. Antonello, S. Ishaq, L. Zanatta, M. Cesarotto, M. Costantini) have no conflicts of interest or financial ties to disclose.

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Antonello, A., Ishaq, S., Zanatta, L. et al. The role of flexible endotherapy for the treatment of recurrent Zenker’s diverticula after surgery and endoscopic stapling. Surg Endosc 30, 2351–2357 (2016). https://doi.org/10.1007/s00464-015-4482-5

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  • DOI: https://doi.org/10.1007/s00464-015-4482-5

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