Cricopharyngeal myotomy with flexible endoscope is a well-known and safe treatment for Zenker’s diverticulum. We describe hereafter how we perform this flexible endotherapy. From January 2011 to January 2017, we treated 28 patients with this endotherapy. Our technique is described step-by-step in the paper: the main principle is to perform an endoscopic cut of the diverticular septum and cricopharyngeal muscle’s fibers (see the video). We describe an objective measurement of the cutting length and depth of the myotomy. Technical success was achieved in all the patients. As to clinical success, 76.2% of patients showed a significant improvement and relevant disappearance of preoperative dysphagia. The present follow-up ranges from 6 months to 5 years. This flexible endoscopic technique can overcome some limitations of rigid endoscopic technique (i.e., upper teeth protrusion, inadequate jaw opening, or limited neck mobility). The main indication was based on clinical presentation and referred to the diverticular dimensions between 2 and 5 cm. Tips for the technique are described in the paper. This variant of cricopharyngeal myotomy with flexible endoscopy is feasible and effective for the treatment of Zenker’s diverticulum in selected patients.
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Compliance with ethical standards
The present study conforms to the guidelines set forth in the Helsinki Declaration of 1975, as revised in 2000, concerning Human and Animal Rights, and the doctors declare that they followed the policy concerning Informed Consent.
Conflict of interest
Dr F. Pugliese, Dr L. Dioscoridi, Dr A. Forgione, Dr E. Forti, Dr M. Cintolo, and Dr M. Mutignani declare that they have no conflict of interest.
Christiaens P, De Roock W, Van Olmen A, et al. Treatment of Zenker’s diverticulum through a flexible endoscope with a transparent 37 oblique-end hood attached to the tip and a monopolar forceps. Endoscopy. 2007;39(2):137–40.CrossRefPubMedGoogle Scholar
Evrard S, Le Moine O, Hassid S, et al. Zenker’s diverticulum: a new endoscopic treatment with a soft diverticuloscope. Gastrointest Endosc. 2003;58(1):116–20.CrossRefPubMedGoogle Scholar
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(2):131–6.CrossRefPubMedGoogle Scholar
Ferreira LE, Simmons DT, Baron TH. Zenker’s diverticula: pathophysiology, clinical presentation, and flexible endoscopic management. Dis Esophagus. 2008;21:1–8.CrossRefPubMedGoogle Scholar
Costamagna G, Mutignani M, Tringali A, et al. Treatment of Zenker’s diverticulum with the help of a plastic hood attached to the endoscope. Gastrointest Endosc. 2002;56:611–2.PubMedGoogle Scholar
Repici A, Pagano N, Fumagalli U, et al. Transoral treatment of Zenker diverticulum: flexible endoscopy versus endoscopic stapling. A retrospective comparison of outcomes. Dis Esophagus. 2011;24:235–9.CrossRefPubMedGoogle Scholar
Costantini M, Zaninotto G, Rizzetto C, et al. Oesophageal diverticula. Best Pract Res Clin Gastroenterol. 2004;18(1):3–17.CrossRefPubMedGoogle Scholar
Vogelsang A, Schumacher B, Preiss C, et al. Efficacy and safety of flexible endoscopic mucomyotomy for Zenker’s diverticulum. Gastrointest Endosc. 2005;61:AB242.CrossRefGoogle Scholar
Dohlman G, Mattsson O. The endoscopic operation for hypopharyngeal diverticula: a Roentgencinematographic study. AMA Arch Otolaryngol. 1960;71:744–52.CrossRefPubMedGoogle Scholar
duVall A, Jones T, McDowell M. Endoscopic myotomy for the treatment of symptomatic Zenker’s diverticulum. Gastrointest Endosc. 2005;61:AB224.Google Scholar
Huberty V, El Bacha S, Blero D, et al. Endoscopic treatment for Zenker’s diverticulum: long-term results (with video). Gastrointest Endoosc. 2013;77:701–7.CrossRefGoogle Scholar
Costamagna G, Iacopini F, Tringali A, et al. Flexible endoscopic Zenker’s diverticulotomy: cap-assisted technique vs. diverticuloscope-assisted technique. Endoscopy. 2007;39(2):146–52.CrossRefPubMedGoogle Scholar
Rabenstein T, May A, Michel J, et al. Argon plasma coagulation for flexible endoscopic Zenker’s diverticulotomy. Endoscopy. 2007;39(2):141–5.CrossRefPubMedGoogle Scholar
Verdonck J, Morton RP. Systematic review on treatment of Zenker’s diverticulum. Eur Arch Otorhinolaryngol. 2015;272:3095–107.CrossRefPubMedGoogle Scholar
Shahawy S, Janisiewicz AM, Annino D, et al. A comparative study of outcomes for endoscopic diverticulotomy versus external diverticulectomy. Otolaryngol Head Neck Surg. 2014;151:646–51.CrossRefPubMedPubMedCentralGoogle Scholar
Parker NP, Misono S. Carbon dioxide laser versus stapler-assisted endoscopic Zenker’s diverticulotomy: a systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2014;150:750–3.CrossRefPubMedPubMedCentralGoogle Scholar
Bizzotto A, Iacopini F, Landi R, et al. Zenker’s diverticulum: exploring treatment options. Acta Otorhinolaryngol Ital. 2013;33:219–29.PubMedPubMedCentralGoogle Scholar