Materiały źródłowe

• #1 Epidemiology and Management of Zenker Diverticulum in a Low-Threshold Single-payer Health Care System

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8678895/

  The annual incidence of Zenker diverticulum was 2.9/100000 person-years, and only 38.2% of patients underwent definitive therapy; management varied across medical specialty and specific catchment area. […] The results of this study suggest that although rare, the incidence of Zenker diverticulum is higher than previously reported and most patients are treated conservatively; further research is needed to risk stratify and identify patients who are most likely to benefit from open or endoscopic correction. […] The total standardized incidence of ZD was 2.89/100000 person-years during the study period (crude incidence, 3.27/100000). […] The main finding of this cohort study was the unexpectedly high number of patients who did not undergo definitive treatment for ZD. […] During the follow-up period, most patients were actively monitored instead of operatively treated. […] The likelihood of operative treatment of ZD being performed depended on which medical specialty treated the patient and the catchment area in which the patient was treated. […] The choice of operative approach depended more on physician-level factors than patient profiles.

• #2 Epidemiology and Management of Zenker Diverticulum in a Low-Threshold Single-payer Health Care System – PubMed

  https://pubmed.ncbi.nlm.nih.gov/34913965/

  The incidence of Zenker diverticulum has been established; previous estimates have been extrapolated from small institutional cohorts. […] To describe the population-wide incidence of Zenker diverticulum over a 20-year period and characterize management strategies across specialties and treatment settings. […] A total of 2736 patients (median [IQR] age at diagnosis 72.0 [19-106] years; 1278 women [46.7%]) were identified, making the annual incidence of Zenker diverticulum in Finland 2.9/100 000 person-years. […] Men had higher incidence (3.7/100 000 person-years) compared with women (2.3/100 000 person-years), with an incidence rate ratio of 1.61 (95% CI, 1.48-1.76; P .001). […] The cohort study results found that the incidence of Zenker diverticulum was 2.9/100 000 person-years. Most patients with Zenker diverticulum did not undergo definitive therapy. Some hospital districts and some medical specialties were more likely to opt for conservative treatment than others. The choice of operative approach depended more on physician-level factors rather than patient profiles.

• #3 The Endoscopic Management of Zenker’s Diverticulum: A Comprehensive Review

  https://www.mdpi.com/2075-4418/14/19/2155

  Zenker’s Diverticulum (ZD) is the most common hypopharyngeal diverticulum; however, it is often underdiagnosed. The estimated prevalence of ZD is 0.01–0.11%, but this is likely underestimated because asymptomatic patients are unlikely to receive a diagnosis. Epidemiological data indicate that ZD is frequently diagnosed in predominantly male patients between the ages of 70 and 80. […] Given the technical issues related to restricted neck mobility and the invasiveness of surgical treatment, endoscopic treatment techniques for ZD have gained traction in recent years. […] Clinical assessment is pivotal because ZD treatment is indicated only in the presence of symptoms. Treatment for symptomatic ZD aims to transect the CM to create a connection between the ZD cavity and the esophageal lumen.

• #4 Zenker Diverticulum: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/836858-overview

  The prevalence of Zenker diverticulum in the United States ranges from 0.01-0.11% of the population. It is more common in males and in the elderly, with a peak incidence in the seventh to ninth decades. […] Zenker diverticula occur more commonly in certain parts of the world. They are observed most often in northern European countries and in countries whose population has a northern European heritage (eg, United States, Canada, Australia). Zenker diverticulum is rarely observed in Japan and Indonesia. The prevalence in high-risk countries is 2 cases per 100,000 people. It has a male-to-female ratio of 1.5:1 and is observed almost exclusively in older individuals.

• #5 Surgical treatment of Zenker diverticula – Porziella – Annals of Esophagus

  https://aoe.amegroups.org/article/view/6218/html

  Zenker diverticula are due to a disorder in the opening of the upper oesophageal sphincter, causing the protrusion of mucosa through the posterior pharyngoesophageal wall. The incidence of Zenker diverticula is estimated between 0.01% and 0.11% and classically occur in males and the elderly. […] The incidence of Zenker diverticula is estimated between 0.01% and 0.11% and classically occurs in males and the elderly, aged 70 to 80 years. […] Therapeutic management of the patient with Zenker diverticulum is fundamentally influenced by the presence or absence of symptoms, the size and location of the diverticulum. Operative treatment should be reserved only for symptomatic patients and for large diverticula (2 cm), in order to improve the quality of life and avoid complications. […] For asymptomatic diverticula smaller than 1 cm, conservative treatment with periodic radiological checks using esophagograms is indicated.

• #6 Zenker’s Diverticulum: Symptoms, Surgery, Causes

  https://www.healthline.com/health/zenkers-diverticulum

  Zenkers diverticulum is rare, affecting between 0.01 and 0.11 percent of the population. It tends to occur in middle-aged and older adults, especially people in their 70s and 80s. Zenkers diverticulum is rare among people under 40. It affects men more often than women. […] Zenkers diverticulum is a rare condition that typically affects older adults. It occurs when a pouch of tissue forms where the pharynx meets the esophagus. […] Mild forms of Zenkers diverticulum may not require treatment. Treatment for moderate to severe forms of Zenkers diverticulum typically involves surgery.

• #7 Zenker’s diverticulum epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Zenker%27s_diverticulum_epidemiology_and_demographics

  The incidence ZD is approximately 2 per 100,000 individuals worldwide. The prevalence of ZD ranges from a low of 10 individuals per 100,000 individuals to a high of 110 individuals per 100,000 individuals worldwide. Mortality rate is 300 per 100,000 individuals for stapled rigid endoscopic procedures. Mortality rate for non-stapled rigid endoscopic procedures is 200 individuals per 100,000 individuals. ZD commonly affects middle-aged and elderly individuals, especially people in their 7th and 8th decades. There is no racial predilection to ZD. Males are more commonly affected by ZD than females. The men to women ratio is approximately 1.5 to 1. The majority of ZD cases are reported in northern Europe.

• #8 Zenker’s Diverticulum: Endoscopic Staple-Assisted Diverticulotomy | Journal of Medical Insight

  https://jomi.com/article/275/zenker’s-diverticulum:-endoscopic-staple-assisted-diverticulotomy

  Zenker’s diverticulum (ZD) is the most common type of esophageal diverticula, typically presents in patients older than 70 years of age, and is slightly more common in males. ZD protrudes through Killians triangle, which is an area of least resistance between the oblique fibers of the inferior pharyngeal constrictors and the cricopharyngeus (CP) muscle. The overall prevalence of ZD is believed to be between 0.01-0.11%. ZD has a higher prevalence in the USA, Canada, and Australia compared with Japan and Indonesia. […] Given the relative infrequency of Zenkers diverticulum, it remains challenging to establish clear clinical and endoscopic guidelines that improve patient outcomes.

• #9 Zenker’s Diverticulum: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/zenkers-diverticulum

  Zenkers diverticulum typically affects people aged 70 to 90. […] Studies estimate about 2 in 100,000 people develop this condition. […] Zenkers diverticulum typically affects people ages 70 to 90. […] You may have this condition for years before you develop noticeable symptoms, and it doesnt go away on its own.

• #10 Zenker diverticulum | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/zenker-diverticulum-1?lang=us

  More than 50% of the affected patients present in 60-80 years of life. It is rarely found in individuals less than 40 years of age 5. […] A Zenker diverticulum may be surgically treated with an endoscopic, surgical diverticulectomy, or diverticulopexy.

• #11 Zenker’s diverticulum – ENT Info

  https://www.entinfo.nz/zenkers-diverticulum/

  ZD occurs most commonly in elderly patients. It is rare before the age of 40 years. It is typically seen in older adults in their seventh or eighth decade of life. […] Males are more commonly affected by ZD with the men to women ratio of about 1.5:1. […] ZD-associated SCC incidence ranges from 0.3-0.5%. […] The risk of cancer development is higher in older patient, male sex, patient with long history of ZD, and large ZD size.

• #12 Pharyngeal Pouch (Zenker’s diverticulum) information

  https://patient.info/doctor/pharyngeal-pouch

  It is uncommon (rates range from 0.01% to 0.11% of the population), but the incidence appears to be higher in Northern Europe than elsewhere. It is largely confined to those aged over 70 years and males outnumber females by 5:1. […] The usual presenting features are dysphagia, regurgitation, aspiration, chronic cough and weight loss.

• #13 Surgical treatment of Zenker diverticula – Porziella – Annals of Esophagus

  https://aoe.amegroups.org/article/view/6218/html

  Symptoms that would induce a surgical approach to Zenker diverticulum include episodes of aspiration pneumonia or inhalation of food material in the airways, regurgitation of food, dysphagia, dyspepsia, halitosis or a feeling of suffocation. […] There is still an open debate on which of the two approaches is best for the patient and how each of them carries risks and benefits but, to our knowledge, no prospective comparative studies were reported. […] Most of the relevant data suggest that open surgery has a better clinical success rates and a higher complication rate than the endoscopic treatment. […] The resolution of symptoms with the open approach is approximately 9395% and the relapse rate of 2.9%. Compared with endoscopic treatments, the morbidity and mortality rates were higher (11% vs. 8.7% and 0.9% vs. 0.4% for the open and endoscopic approach respectively).

• #14 Indication for the endoscopic treatment of Zenker’s diverticula – Rodríguez-Luna – Annals of Esophagus

  https://aoe.amegroups.org/article/view/5814/html

  Zenkers diverticulum (ZD) is a rare disease with an incidence of 1/100,000 cases with a higher prevalence in the elderly population (patients aged between 70 and 80 years), usually with a high comorbidity. […] ZD incidence is uncommon, and it is mostly present in the elderly population. […] The high recurrence rate (~50%) after flexible endoscopy can be explained by incomplete septotomy due to poor visualization or resulting from the concern related to risk of mediastinal perforation. The current clinical evidence on Z-POEM is still scarce and limited mostly to case series reports. […] The success rate of rigid endoscopy (90-100%) is comparable to the conventional open approach (80-100%). […] A meta-analysis published in 2016 with including 11 articles compared the surgical approach with the endoscopic treatment. The endoscopic treatment was found superior in terms of shorter procedure times and lengths of hospital stay, earlier oral diet resumption, and lower complication rates. […] The evidence of flexible endoscopic myotomy is scant and mostly derived from case series in which the long-term follow-up is missing.

• #15 Surgical treatment of Zenker diverticula – Porziella – Annals of Esophagus

  https://aoe.amegroups.org/article/view/6218/html

  The risks of transcervical treatment of Zenkers diverticulum are partly inherent the more invasive surgical procedure itself, and partly reside in the fact that this disease often afflicts an elderly population. […] Moroco et al. (23), in their recent study of the NSQIP Database, analyzed 614 elderly patients submitted to open surgery for ZD, observing a complication rate of 6.7%, readmission rate of 7.2%, and reoperation rate of 6.4%, with a very low mortality rate of 0.3%. […] Despite the mean age of our patients (65.010.9 years) and the inevitable comorbidity of the third age of life, we did not observe any mortality and major complication in our experience. […] Surgery-related mortality, in the Verdonk and Morton review (20), is low in either method (0.9%); they reported a morbidity rate of 11% for the transcervical approach (especially hematomas, fistulas and recurrent laryngeal nerve palsy) and 7% for the endoscopic procedures (mediastinitis or subcutaneous emphysema mainly). […] Open approach seems to be a safe, feasible, and effective option to improve dysphagia and regurgitation, with a very small rate of complications, despite the mean age of the patients.

• #16 The Endoscopic Management of Zenker’s Diverticulum: A Comprehensive Review

  https://www.mdpi.com/2075-4418/14/19/2155

  Although there is not a universally accepted and specific symptom score for the clinical evaluation of ZD patients, different scores have been used. […] The most recent study with long-term data on FESD is a prospective single-center study by Repici A. et al., which included 256 patients treated with FESD. After achieving a CS rate of 96.1%, symptom recurrence occurred in 31.3% (80/256) of patients at a mean time of 9 ± 3 months, as defined by the DB score. […] The endoscopic management of ZD has evolved significantly in recent years. The first technique introduced, FESD, has been complemented over the past 20 years by the application of advanced third-space endoscopic procedures to the treatment of ZD, with techniques such as Z-POEM and POES.

• #17 Zenker’s diverticulum in an 85-year-old Ugandan man | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-021-01914-2

  Zenkers diverticulum (ZD), is a rare disorder with an estimated prevalence ranging between 0.01 and 0.11% in the general population. […] Esophageal diverticula are rare, with a radiologic and endoscopic prevalence of 0.064%, in which Zenkers is the most common. […] Barium swallow is the most important diagnostic tool for dysphagia. […] ZD is managed surgically either by open left cervical incision or minimally invasive endoscopic approach. […] In conclusion, ZD is a rare condition of the proximal esophagus, typically presents in elderly population. Barium swallow is the most important diagnostic tool in the diagnosis of ZD. Presenting symptoms can overlap with malignant conditions of the esophagus. High index of suspicion is needed to diagnose this condition as it is rare in the general population.

• #18 Zenker’s Diverticulum | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/z/zenkers-diverticulum.html

  Zenker’s diverticulum is a pouch at the back of the throat at a weak spot where the throat and esophagus join. These diverticula are uncommon and tend to occur in elderly people. […] A barium swallow is the most effective way to diagnose a Zenker’s diverticulum. […] Zenker’s diverticula are normally not treated unless they cause symptoms.

• #19 A Patient With a Zenker’s Diverticulum Showing Symptoms Similar to Acute Coronary Syndrome | Oyama | Journal of Medical Cases

  https://www.journalmc.org/index.php/JMC/article/view/2311/1721

  Symptoms associated with ZD may be present for weeks to years before its definite diagnosis. However, the trigger mechanism by which asymptomatic ZD changes into symptomatic ZD is unclear. Commonly, the size of ZD is strongly related to the appearance of the various symptoms; small diverticula may not cause symptoms, but larger diverticula are usually symptomatic and patients with very large diverticula may show a gurgling swelling that is palpable in the neck. […] Therefore, although ZD is a rare disease, physicians should know that ZD might be found in asymptomatic patients who have regularly undergone periodic examinations of the upper gastrointestinal tract. […] The usefulness of chest CT for the diagnosis of ZD is unclear. Gorkem et al reported a pediatric case in which chest CT findings of a large esophageal pouch filled with food and air particles led to definite diagnosis of ZD. In another case, multiple examinations by chest CT could not identify a large ZD (4 cm in diameter). In our case, an air particle in the left retrohypopharyngeal space on CT was the decisive factor in considering the possibility of ZD. Accordingly, physicians must not miss unusual air particles adjacent to the hypopharynx on CT, which suggest the possibility of ZD.

• #20 Epidermoid carcinoma occurring in a Zenker’s diverticulum | Cirugía Española (English Edition)

  https://www.elsevier.es/en-revista-cirugia-espanola-english-edition–436-articulo-epidermoid-carcinoma-occurring-in-zenkers-S217350772100048X

  Malignant degeneration is a rare complication of pharyngeal diverticula, with an incidence reported in the literature ranging from 0.3% to 7%.1 The first description was by Halstead in 1904. Since then, publications have been scarce, and most have been isolated case reports, so there is no consensus regarding its management. […] Risk factors for malignization of a diverticulum include advanced age, male sex, large size, and long-term progression of the diverticulum.2 The latter is the main predisposing factor due to chronic irritation of the diverticular lining caused by food retention.3 […] Patients with Zenker’s diverticula must be carefully monitored before and after surgical treatment since a carcinoma can develop even after resection of the diverticulum.2 […] In conclusion, despite the low incidence of carcinoma in Zenker’s diverticulum, it must be considered in the differential diagnosis, especially in patients with long-term diverticula or changes in symptoms, in whom esophagoscopy and barium swallow should be performed. If diagnosed, surgery is recommended depending on the stage, which may or may not be associated with chemo-radiotherapy.

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