Interdisciplinary Comparison of Endoscopic Laser-Assisted Diverticulotomy vs. Transcervical Myotomy as a Treatment for Zenker’s Diverticulum



Currently, there are different competing techniques for the treatment of Zenker’s diverticulum (ZD). To improve patient selection, we compared endoscopic laser-assisted diverticulotomy (ELAD) with transcervical myotomy (TCM) with regard to possible risk factors for treatment failure.


Data of ZD patients (n = 104) treated between 2004 and 2016 with either TCM (38%) or ELAD (62%) were analyzed retrospectively. Univariate and multivariate analyses were performed.


TCM is associated with a higher morbidity (27.8% vs. 10.2%; p = 0.095) but lower recurrence rate (7.3% vs. 19.3%; p = 0.095). Preoperative reflux disease (OR 8.755; p = 0.021) was identified as an independent risk factor for complications.


Although short-term outcome and symptom relief are similar, TCM tends to have a higher complication rate but better long-term results. Preoperative reflux disease is an independent risk factor for postoperative complications.

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Fig. 1


  1. 1.

    Ludlow, A., A case of obstructed deglutition from a preternatural dilatation of and bag formed in the pharynx. Medical Observations and Enquiries by a Society of Physicians in London., 1769. 2: pp. 85–101.

  2. 2.

    Friedrich A. Zenker, H.Z., Handbuch der Krankheiten des chylopoëtischen Apparates. Handbuch der speciellen Pathologie und Therapie. Vol. 7. 1877, Leipzig: F. C. W. Vogel.

  3. 3.

    Siddiq, M.A., S. Sood, and D. Strachan, Pharyngeal pouch (Zenker’s diverticulum). Postgrad Med J, 2001. 77(910): p. 506–11.

    CAS  Article  Google Scholar 

  4. 4.

    Welsh, G.F. and W.S. Payne, The present status of one-stage pharyngo-esophageal diverticulectomy. Surg Clin North Am, 1973. 53(4): p. 953–8.

    CAS  Article  Google Scholar 

  5. 5.

    Dohlman, G. and O. Mattsson, The endoscopic operation for hypopharyngeal diverticula: a roentgencinematographic study. AMA Arch Otolaryngol, 1960. 71: p. 744–52.

    CAS  Article  Google Scholar 

  6. 6.

    Collard, J.M., J.B. Otte, and P.J. Kestens, Endoscopic stapling technique of esophagodiverticulostomy for Zenker’s diverticulum. Ann Thorac Surg, 1993. 56(3): p. 573–6.

    CAS  Article  Google Scholar 

  7. 7.

    van Overbeek, J.J., Meditation on the pathogenesis of hypopharyngeal (Zenker’s) diverticulum and a report of endoscopic treatment in 545 patients. Ann Otol Rhinol Laryngol, 1994. 103(3): p. 178–85.

    Article  Google Scholar 

  8. 8.

    Knegt, P.P., P.C. de Jong, and E.J. van der Schans, Endoscopic treatment of the hypopharyngeal diverticulum with the CO2 laser. Endoscopy, 1985. 17(6): p. 205–6.

    CAS  Article  Google Scholar 

  9. 9.

    Greene, C.L., et al., Long-term outcome of the treatment of Zenker’s diverticulum. Ann Thorac Surg, 2015. 100(3): p. 975–8.

    Article  Google Scholar 

  10. 10.

    Leibowitz, J.M., et al., Surgical techniques for Zenker’s diverticulum: a comparative analysis. Otolaryngol Head Neck Surg, 2014. 151(1): p. 52–8.

    Article  Google Scholar 

  11. 11.

    Dindo, D., N. Demartines, and P.-A. Clavien, Classification of surgical complications. Annals of Surgery, 2004. 240(2): p. 205–213.

    Article  Google Scholar 

  12. 12.

    Chang, C.W., et al., Carbon dioxide laser endoscopic diverticulotomy versus open diverticulectomy for Zenker’s diverticulum. Laryngoscope, 2004. 114(3): p. 519–27.

    Article  Google Scholar 

  13. 13.

    Koch, M., et al., Endoscopic laser-assisted diverticulotomy versus open surgical approach in the treatment of Zenker’s diverticulum. Laryngoscope, 2011. 121(10): p. 2090–4.

    Article  Google Scholar 

  14. 14.

    Bonavina, L., et al., Long-term outcome and quality of life after transoral stapling for Zenker diverticulum. World J Gastroenterol, 2015. 21(4): p. 1167–72.

    Article  Google Scholar 

  15. 15.

    Albers, D.V., et al., Endoscopic versus surgical approach in the treatment of Zenker’s diverticulum: systematic review and meta-analysis. Endosc Int Open, 2016. 4(6): p. E678–86.

    Article  Google Scholar 

  16. 16.

    Verdonck, J. and R.P. Morton, Systematic review on treatment of Zenker’s diverticulum. Eur Arch Otorhinolaryngol, 2015. 272(11): p. 3095–107.

    Article  Google Scholar 

  17. 17.

    Ishaq, S., et al., Flexible endoscopic treatment for Zenker’s diverticulum: a systematic review and meta-analysis. Gastrointest Endosc, 2016. 83(6): p. 1076–1089 e5.

    Article  Google Scholar 

  18. 18.

    Gutschow, C.A., et al., Management of pharyngoesophageal (Zenker’s) diverticulum: which technique? Ann Thorac Surg, 2002. 74(5): p. 1677–82; discussion 1682-3.

    Article  Google Scholar 

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Author information




Philipp Nitschke: study design, data analysis, data interpretation, drafting of the manuscript.

Max Kemper: data acquisition, data interpretation, manuscript revision.

Patricia König: data acquisition, data analysis, manuscript revision.

Thomas Zahnert: data interpretation, manuscript revision.

Jürgen Weitz: data interpretation, manuscript revision.

Christoph Reissfelder: data interpretation, manuscript revision.

Marius Distler: study design, data acquisition, data interpretation, manuscript revision

Corresponding author

Correspondence to Marius Distler.

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Nitschke, P., Kemper, M., König, P. et al. Interdisciplinary Comparison of Endoscopic Laser-Assisted Diverticulotomy vs. Transcervical Myotomy as a Treatment for Zenker’s Diverticulum. J Gastrointest Surg 24, 1955–1961 (2020).

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  • Zenkers diverticulum
  • Endoscopic diverticulotomy
  • Transcervical myotomy