Endoscopic Staple Diverticulostomy for Zenker Diverticulum

  • William J. RichtsmeierEmail author
  • Richard L. Scher


Endoscopic treatment of Zenker diverticulum became more readily accepted with the descriptions of the use of the Endo GIA stapler to divide and “seal” the common wall between the esophagus and the diverticulum. This technique creates an esophagodiverticulostomy and has consistently led to relief of patient symptoms with decreased rates of complications as compared to other endoscopic approaches. Treatment of Zenker diverticulum with endoscopic staple diverticulostomy offers the ability for patients to have rapid convalescence with resumption of regular diet in most cases. This chapter will discuss the surgical technique, expected outcomes, and possible complications of this approach while comparing ESD to other endoscopic approaches.


Endoscopic Zenker Diverticulum Staple Weerda Esophagodiverticulostomy 


  1. 1.
    Mosher HP. Webs and pouches of the esophagus, their diagnosis and treatment. Surg Gynecol Obstet. 1917;25:175–87.Google Scholar
  2. 2.
    Dohlman G, Mattsson L. The endoscopic operation for hypopharyngeal diverticula. A roentgencinematographic study. Arch Otolaryngol Head Neck Surg. 1960;71:744–52.CrossRefGoogle Scholar
  3. 3.
    van Overbeek JJ. Meditation on the pathogenesis of hypopharyngeal (Zenker’s) diverticulum and a report of endoscopic treatment in 545 patients. Ann Otol Rhinol Laryngol. 1994;103:178–85.CrossRefPubMedGoogle Scholar
  4. 4.
    Martin-Hirsch DP, Newbegin CJ. Autosuture GIA gun: a new application in the treatment of hypopharyngeal diverticula. J Laryngol Otol. 1993;107:723–5.CrossRefPubMedGoogle Scholar
  5. 5.
    Collard JM, Otte JB, Kestens PJ. Endoscopic stapling technique of esophagodiverticulostomy for Zenker’s diverticulum. Ann Thorac Surg. 1993;56:573–6.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Scher RL, Richtsmeier WJ. Endoscopic staple-assisted esophagodiverticulostomy for Zenker’s diverticulum. Laryngoscope. 1996;106:951–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Chang C, Payyapilli R, Scher RL. Endoscopic staple diverticulostomy for Zenker’s diverticulum: review of literature and experience in 159 consecutive patients. Laryngoscope. 2003;113:957–65.CrossRefPubMedGoogle Scholar
  8. 8.
    Wilken R, Whited C, Scher RL. Endoscopic staple diverticulostomy for Zenker’s diverticulum: review of experience in 337 cases. Ann Otol Rhinol Laryngol. 2015;124:21–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Thaler ER, Weber RS, Goldberg AN, Weinstein GS. Feasibility and outcome of endoscopic staple-assisted esophagodiverticulostomy for Zenker’s diverticulum. Laryngoscope. 2001;111:1506–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Richtsmeier WJ. Myotomy length determinants in endoscopic staple-assisted esophagodiverticulostomy for small Zenker’s diverticula. Ann Otol Rhinol Laryngol. 2005;114:341–6.CrossRefPubMedGoogle Scholar
  11. 11.
    McGuire J, Wright IC, Leverment JN. Surgical staplers: a review. J R Coll Surg Edinb. 1997;42:1–9.PubMedGoogle Scholar
  12. 12.
    Richtsmeier WJ, Monzon JR. Postendoscopic Zenker esophagodiverticulostomy leaks associated with a specific stapler cartridge. Arch Otolaryngol Head Neck Surg. 2002;128:137–40.CrossRefPubMedGoogle Scholar
  13. 13.
    Hollinger LD. Patient examination, endoscopy and biopsy. In: Cummings CW, Fredrickson JM, editors. Otolaryngology – head and neck surgery, vol. III. St. Louis: CV Mosby; 1986. p. 2264.Google Scholar
  14. 14.
    Acharya A, Jennings S, Douglas S, Mirza S, Beasley N. Carcinoma arising in a pharyngeal pouch previously treated by endoscopic stapling. Laryngoscope. 2006;116:1043–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Herbella FA, Dubecz A, Patti MG. Esophageal diverticula and cancer. Dis Esophagus. 2012;25:153–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Chekan E, Whelan RL. Surgical stapling device-tissue interactions: what surgeons need to know to improve patient outcomes. Med Devices (Auckl). 2014;7:305–18.PubMedCentralGoogle Scholar
  17. 17.
    Roth JA, Sigston E, Vallance N. Endoscopic stapling of pharyngeal pouch: a 10-year review of single versus multiple staple rows. Otolaryngol Head Neck Surg. 2009;140:245–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Jaramillo MJ, McLay KA, McAteer D. Long-term clinico-radiological assessment of endoscopic stapling of pharyngeal pouch: a series of cases. J Laryngol Otol. 2001;115:462–6.PubMedGoogle Scholar
  19. 19.
    Ong CC, Elton PG, Mitchell D. Pharyngeal pouch endoscopic stapling—are post-operative barium swallow radiographs of any value? J Laryngol Otol. 1999;113:233–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Hadley JM, Ridley N, Djazaeri B, et al. The radiological appearances after the endoscopic cricopharyngeal myotomy: Dohlman’s procedure. Clin Radiol. 1997;52:613–5.CrossRefPubMedGoogle Scholar
  21. 21.
    Sydow B, Levine MS, Rubesin SE, et al. Radiographic findings and complications after surgical or endoscopic repair of Zenker’s diverticulum in 16 patients. AJR Am J Roentgenol. 2001;177:1067–71.CrossRefPubMedGoogle Scholar
  22. 22.
    Scher RL, Richtsmeier WJ. Long-term experience with endoscopic staple-assisted esophagodiverticulostomy for Zenker’s diverticulum. Laryngoscope. 1998;108:200–5.CrossRefPubMedGoogle Scholar
  23. 23.
    Peracchia A, Bonavina L, Narne S, et al. Minimally invasive surgery for Zenker’s diverticulum: analysis of results in 95 consecutive patients. Arch Surg. 1998;133:695–700.CrossRefPubMedGoogle Scholar
  24. 24.
    Barton MD, Detwiller KY, Palmer AD, Schindler JS. The safety and efficacy of endoscopic Zenker’s diverticulotomy: a cohort study. Laryngoscope. 2016;126(12):2705–10.CrossRefPubMedGoogle Scholar
  25. 25.
    Cook RD, Huang PC, Richstmeier WJ, et al. Endoscopic staple-assisted esophagodiverticulostomy: an excellent treatment of choice for Zenker’s diverticulum. Laryngoscope. 2000;110:2020–5.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Paleri V, Najim O, Meikle D, Wilson JA. Microlaryngoscopic repair of iatrogenic pharyngeal pouch perforations: treatment of choice? Head Neck. 2007;29:189–92.CrossRefPubMedGoogle Scholar
  27. 27.
    Koay CB, Commins D, Bates GJ. The role of endoscopic stapling diverticulotomy in recurrent pharyngeal pouch. J Laryngol Otol. 1998;112:954–5.CrossRefPubMedGoogle Scholar
  28. 28.
    Scher RL. Endoscopic staple diverticulostomy for recurrent Zenker’s diverticulum. Laryngoscope. 2003;113:63–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Payne WS. The treatment of pharyngoesophageal diverticulum: the simple and complex. Hepatogastroenterology. 1992;39:109–14.PubMedGoogle Scholar
  30. 30.
    Ellis F. Pharyngoesophageal (Zenker’s) diverticulum. Adv Surg. 1995;28:171–89.PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of OtolaryngologyBassett Medical CenterCooperstownUSA
  2. 2.ENT Procedure Innovation and DevelopmentOlympus CorporationTokyoJapan
  3. 3.Division of Head and Neck Surgery and Communication Sciences, Department of SurgeryDuke UniversityDurhamUSA

Personalised recommendations