Materiały źródłowe

• #1

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3773964/

  Zenker’s diverticulum is an acquired sac-like outpouching of the mucosa and submucosa layers located dorsally at the pharyngoesophageal junction through Killian’s dehiscence. […] Treatment is recommended for symptomatic patients and considering the aetiopathogenesis of the disease demands myotomy of the cricopharyngeal muscle. Myotomy may be pursued through either open surgical or endoscopic techniques. […] In recent years, endoscopic repair of Zenker’s diverticulum has been found to be a viable safe and effective alternative to surgery and gained widespread acceptance. Endoscopic stapled diverticulotomy is generally the preferred approach, but flexible endoscopy is a valuable option, particularly for high-risk patients. […] The primary therapeutic aim is to create a communicating door between the diverticulum and the oesophageal lumen by transecting the septum to eliminate the diverticulum reservoir, restore outflow continuity at the pharyngoesophageal segment allowing clearance of ingested bolus and subsequently relief symptoms and prevent recurrence.

• #1

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3773964/

  According to the current focus on the contribution of cricopharyngeal muscle in the genesis of ZD, treatment imposes mytomy of the cricopharyngeal muscle independently of the additional procedure (creation of a plain oesophagodiverticulostomy, diverticulectomy or suspension diverticulopexy). […] Treatment procedures for ZD encompass open cricopharyngeal myotomy with diverticulectomy or diverticulopexy or diverticular inversion, myotomy alone, endoscopic staple-assisted oesophagodiverticulostomy, endoscopic CO2-laser myotomy, endoscopic harmonic scalpel diverticulotomy and flexible endoscopic diverticulotomy. […] The management of patients with pharyngeal pouch may be either conservative (for smaller than 1 cm, asymptomatic diverticula) or surgical through an incision in the neck (open) or mouth (endoscopic).

• #2 Zenker Diverticulum – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499996/

  Zenker diverticulum develops in the hypopharynx, typically between the cricopharyngeus muscle and the inferior pharyngeal constrictor muscle at the level of cervical vertebrae 5 and 6. […] This activity reviews the evaluation and management of Zenker diverticulum and highlights the role of the interprofessional team in the recognition and management of this condition. […] Explain the recommended treatment of Zenker diverticulum. […] Only symptomatic lesions need treatment; lesions less than 2 centimeters rarely require any treatment. In some cases of Zenker diverticulum associated with achalasia, botulinum toxin may help relieve symptoms of dysphagia. For all other large Zenker diverticulum, surgery is indicated. […] The Zenker diverticulum can be treated by an open procedure or via an endoscopic approach. During surgery, it is vital to divide the cricopharyngeus muscle to relieve the elevated pressure zone and eliminate the pouch of the diverticulum. A 1-cm myotomy is adequate in most cases.

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

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

  Zenker diverticula require intervention only if they produce symptoms. In general, small (ie, 2 cm) lesions found incidentally require no intervention. However, some surgeons contend that because these lesions are likely to become larger with time, intervention ought to be considered in younger, healthier, asymptomatic patients with Zenker diverticula. […] Small lesions are satisfactorily treated with a CP myotomy with or without an invagination procedure. Intermediate and large diverticula (ie, 2-6 cm) are best managed with open diverticulectomy with CP myotomy or by endoscopic diverticulotomy. Very large diverticula (ie, 6 cm) are best managed with excision with CP myotomy or a diverticulopexy with CP myotomy, depending on the health of the patient. […] Indications for the repair of Zenker diverticulum are broad. The diverticulum can frequently be the etiology for aspiration and pneumonia and should therefore be repaired in patients capable of tolerating the operative procedure.

• #4 Zenker’s diverticulum – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/zenkers-diverticulum/diagnosis-treatment/drc-20568846

  To treat Zenker’s diverticulum, surgery or other procedures may be needed. Eating softer foods in smaller bites might help with swallowing if you have mild symptoms of Zenker’s diverticulum. Your healthcare professional might suggest a dietician to help you learn what to eat. […] Repairing the esophagus with a procedure or surgery is the most common treatment for Zenker’s diverticulum that’s causing symptoms. Often, ear, nose and throat conditions (ENT) specialists do the procedure or surgery. They often do the procedure through a tube called an endoscope that goes into the mouth to the esophagus. This is less invasive than open surgery. […] Endoscope procedures to repair Zenker’s diverticulum, sometimes called endoscopic repairs, most often have shorter surgery times and may have a shorter hospital stay compared to open surgery. They also often have similar results and improve Zenker’s diverticulum symptoms for people as much as open surgery. But people who have endoscope procedures might have a higher risk of a Zenker’s diverticulum coming back.

• #5 Zenker’s Diverticulum | Temple Health

  https://www.templehealth.org/services/conditions/zenkers-diverticulum

  Mild cases of Zenkers diverticulum may require little more than changes to how an individual eats, such as chewing foods well, drinking a lot of water after meals, and eliminating high-fat, spicy and acidic foods from the diet. […] Cases that are moderate to severe usually require surgery. Left untreated, Zenkers diverticulum can worsen over time, continuing to enlarge and possibly leading to malnutrition. The following types of surgery are available, but which type is chosen depends on the pouchs size and location. […] Cricopharyngeal myotomy is often used for small Zenkers diverticulum, this procedure involves cutting a muscle in the esophagus to help ease swallowing. […] Diverticulopexy with cricopharyngeal myotomy is a procedure where surgeons attach the pouch to the wall of the esophagus, rather than removing it. It is often used for larger Zenkers diverticulum.

• #5 Zenker’s Diverticulum | Temple Health

  https://www.templehealth.org/services/conditions/zenkers-diverticulum

  Diverticulectomy and cricopharyngeal myotomy involves the complete removal of the diverticulum. […] Endoscopic diverticulotomy is one of the more common procedures for this condition, involving surgeons splitting the wall that separates the esophagus from the diverticulum, which allows food to enter the esophagus.

• #6 Zenker’s Diverticulum: Symptoms and Treatment

  https://www.webmd.com/digestive-disorders/what-is-zenkers-diverticulum

  Treatment for Zenkers depends on the size and severity of the pouch. If your diverticulum is less than one-quarter of an inch in size or if you dont have bothersome symptoms, you most likely wont need any surgery. […] Mild cases of Zenkers diverticulum can be managed by changing how and what you eat. If your diverticulum isnt large enough to require surgery, one thing that you can do is to make sure that you fully chew your food so that its easier to swallow. After eating, be sure to drink water to flush down any food that might be stuck in your throat. Cutting out spicy and acidic foods may also help reduce your symptoms. […] More serious cases of Zenkers diverticulum require surgery. Surgery can help with difficulty swallowing, coughing, and aspiration. For large diverticula, or for those in complicated positions, an open-neck surgery might be the only way to remove the pouch.

• #7 What is Zenker’s Diverticulum? (Causes, Signs, and Treatment)

  https://www.houstonent.com/blog/what-is-zenkers-diverticulum-symptoms-and-signs

  The only treatment to cure Zenker’s diverticulum is a surgical intervention, which relieves symptoms and improves the quality of life. […] Presently, there aren’t any medications yet that treats the condition and if you leave the condition untreated, you’ll continue to have trouble swallowing which can cause malnutrition, weight loss or pneumonia as food enters your lungs from the pouch. […] This condition can even be life-threatening, although that’s uncommon.

• #8 Treatment of Zenker’s diverticulum – Mayo Clinic

  https://www.mayoclinic.org/medical-professionals/digestive-diseases/news/treatment-of-zenkers-diverticulum/mac-20431393

  Treatment for symptomatic ZD can be surgical or endoscopic. The surgical approach involves an external neck incision with CP myotomy (diverticulotomy), with or without pouch intervention (inversion, diverticulopexy or diverticulectomy). […] The endoscopic approach, using rigid or flexible endoscopes, involves only a diverticulotomy, in which the septum between the esophageal lumen and the diverticulum and the CP muscle are severed to create a single channel. […] Each of these treatment approaches has variations in techniques and associated advantages and disadvantages. […] The endoscopic approach using rigid endoscopes also offers symptom relief in at least 90 percent of patients, with a 7 to 8 percent risk of adverse events, which include dental injury and perforation. […] Flexible endoscopic therapy for ZD is becoming more widely accepted as newer data show sustained efficacy that is comparable to open surgical and rigid endoscopic therapies. […] The flexible endoscopic approach has demonstrable advantage over rigid endoscopy by way of control, ease and therapeutic options. […] We offer flexible endoscopic ZD myotomy with modified technique, aiming for higher efficacy and fewer adverse events.

• #9 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 false pulsion diverticulum located in Killians triangle. […] The current therapeutic modalities are based on CPM myotomy to eliminate diverticular bolus retention, improve bolus flow, relieve outflow obstruction, and mitigate neuromotor impairment. […] The conventional open approach through a left cervicotomy has been mostly replaced by transoral techniques using either rigid endoscopy or flexible endoscopes. […] Endoscopic techniques present several advantages in terms of lower risk of adverse events, can be accomplished without the need for general anesthesia and neck hyperextension, and provide for a rapid patient recovery. […] The recent introduction of cutting-edge technology Z-POEM allows through a direct septal visualization for a complete myotomy, leading to a lower recurrence rate and higher symptoms resolution than endoscopic septotomy.

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

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

  Therapeutic management of ZD is guided by two main factors; patients symptoms and diverticular size. […] Surgical treatment should be addressed to symptomatic patients with or without associated complications with the objective of relieve symptoms and improve quality of life. […] Two main approaches for the ZD management have been described, namely open and transoral (endoscopic) approaches. […] Nowadays the open surgical approach is no longer the gold standard. […] With the evolution of endoscopic techniques as well as an improved understanding of the underlying pathophysiology, ZD is mainly treated with transoral endoscopic flexible or rigid techniques due to their cost-effectiveness and lower risk of adverse events as compared to the conventional open approach. […] The open approach continues to be an efficient option for patients with complex ZD endoscopic exposure, reported in 4.418% of the procedures, and in selected cases such as patients in whom symptomatology persists after the initial therapy and are suitable for reintervention.

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

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

  The flexible endoscopic treatment of ZD with septotomy was introduced in 1995 by Mulder and Ishioka. […] This technique has been previously applied to poor surgical candidates with anatomical conditions which made difficult to achieve an adequate exposure under rigid esophagoscopy. […] The objectives of the procedure are similar to rigid endoscopy and open techniques, namely CPM myotomy, and septum reduction to less than 1 cm. […] To prevent recurrence, other groups have used an extended myotomy into the esophageal wall for 5 to 10 mm beyond the diverticular tip. […] The submucosal tunneling technique was developed to overcome this limitation. […] The current clinical evidence on Z-POEM is still scarce and limited mostly to case series reports. […] Stronger clinical evidence will come from the ZIPPY trial, a prospective, international, multicenter, double-blind, randomized study, with the aim to compare the short-term and long-term clinical outcomes of Z-POEM versus flexible endoscopic septotomy which will start in 2021. […] Rigid and flexible transoral approaches have become the first-line therapy of ZD management, replacing the traditional open approach, due to the consistent superiority in terms of faster oral intake resumption, shorter operative times and shorter length of hospital stay.

• #10

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3773964/

  The operation is usually performed under general anaesthesia, but can also be performed under local anaesthesia or C5-C6 superselective spinal anaesthesia. […] The management of Zenker’s diverticulum has dramatically progressed during past decades. […] Endoscopic stapling diverticulotomy has gained widespread acceptance and is often considered the first-line choice for treatment of ZD. […] Endoscopic CO2 laser-assisted diverticulostomy, first introduced in 1981, is a sutureless technique where the septum is divided by CO2 laser. […] Flexible endoscopy is an appealing safe and effective minimally-invasive treatment option for ZD, with good clinical outcome, acceptable recurrence, and complication rates.

• #11 1-Minute Consult: Are There Alternatives to Surgery for Zenker Diverticulum?

  https://consultqd.clevelandclinic.org/1-minute-consult-alternatives-surgery-zenker-diverticulum

  Conventional treatment for a large symptomatic Zenker diverticulum is to surgically either remove it (diverticulectomy) or obliterate it by repositioning and securing it after cutting into the cricopharyngeus muscle (diverticulopexy with cricopharyngeal myotomy). […] Most experts recommend cricopharyngomyotomy in addition to any treatment strategy. […] In centers that do not offer flexible endoscopy, and for patients with a large diverticulum, open surgery is the sole option. […] Success rates for open surgery vary from study to study but are usually around 90%. […] All endoscopic procedures involve incision of the wall separating the diverticulum from the esophageal lumen to relieve the obstruction. […] Flexible endoscopy is the first-line therapy for most patients in many centers.

• #11 1-Minute Consult: Are There Alternatives to Surgery for Zenker Diverticulum?

  https://consultqd.clevelandclinic.org/1-minute-consult-alternatives-surgery-zenker-diverticulum

  We recommend flexible endoscopy for the initial treatment of Zenker diverticulum in most patients, but its availability is limited in the United States, as many practitioners do not have adequate experience with the technique. […] For a large diverticulum, we recommend an open cervical procedure involving excision of the diverticulum or a diverticulopexy for patients who are good surgical candidates.

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

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

  A retrospective study by Uoti et al indicated that in the surgical treatment of Zenker diverticulum, the occurrence of complications is associated with patient age, the surgical technique used, and the clinicians surgical specialty. […] The 2 key elements for the successful surgical management of a Zenker diverticulum are division of the CP muscle to eliminate the potentially elevated pressure zone and elimination of the diverticular pouch as a reservoir of food and secretions. […] The 2 most commonly performed surgical procedures are diverticulectomy with CP myotomy and endoscopic diverticulotomy with a stapler. […] A study by Venkatesan found that after successful endoscopic diverticulotomy in patients with Zenker diverticulum, videofluoroscopic swallow study (VFSS) showed a 50.9% reduction in diverticulum size and a 33.6% reduction in the pharyngeal constriction ratio, as well as a 61.6% increase in the mean pharyngoesophageal segment opening in the lateral view and a 40.0% increase in the anteroposterior view. […] A study by Adam et al examining the efficacy of CO2 laser versus stapling technique in the endoscopic repair of Zenker diverticulum found that although both procedures were effective in treating the condition, the laser technique was more effective.

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

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

  Flexible endoscopic approaches have been developed over the past few decades as safe and effective alternatives to surgery for ZD treatment. These endoscopic techniques aim to address the challenges associated with traditional surgical methods, such as the invasiveness of open surgery and the technical difficulties posed by rigid endoscopes. Since ZD predominantly occurs in the elderly, who often have multiple comorbidities and a higher surgical risk, a minimally invasive endoscopic approach offers significant advantages. […] FESD has demonstrated high clinical efficacy, with CS rates ranging from 90% to 100% across multiple studies. In a meta-analysis by Ishaq et al., including 20 studies with 813 patients with ZD treated by FESD, the CS rate was 91%. […] Z-POEM demonstrated similar safety outcomes compared to FESD.

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

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

  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. Additionally, hybrid techniques have emerged, aiming to combine the benefits of various approaches while minimizing their limitations.

• #14 Flexible endoscopic treatment of Zenker’s diverticulum: a retrospective study in a single center from Turkey

  https://www.e-ce.org/journal/view.php?number=7953

  Fifteen patients with symptomatic Zenkers diverticulum were treated with 16 cricopharyngeal myotomies. […] While advances in interventional flexible endoscopy have opened doors for novel treatments, cricopharyngeal myotomy based on traditional flexible endoscopic septal division remains a reliable approach for treating Zenkers diverticulum. […] Treatment for ZD is indicated when symptoms arise, regardless of diverticular size. […] Essentially, treatment consists of dividing the cricopharyngeal muscle that helps to control the opening of the esophagus. […] Flexible endoscopy was introduced as an alternative for treating ZD in 1995. […] The most prevalent approach to treating ZD is to cut or split the cricopharyngeal septum via septotomy or myotomy so that the upper esophageal sphincter can relax and the diverticulum can shrink.

• #15 Pharyngeal Pouch/ Zenkers Diverticulum Treatment London

  https://drrehanhaidry.com/pharyngeal-pouch-zenkers-diverticulum/

  Up until recently the only treatment for Zenkers Diverticulum was open surgery (under general anaesthetic) performed via incisions in the throat. During the surgery a stapling tool is inserted through this cut which uses staples to close the pouch. However the operation risks infection and bleeding risk, making it unsafe for many elderly patients. Whats more, the staples can loosen over time, causing the pouch to re-form. […] Dr Haidry was the first to introduce a pioneering new endoscopic procedure called Zenkers Peroral Endoscopic Myotomy (Z-POEM). Its minimally invasive, making it a preferred option for a condition which is more common in elderly patients. […] Z-POEM is an endoscopic procedure (performed via a tube down the throat), which means its incisionless (no cuts to the neck/throat) and less risky than surgery.

• #16 Zenker’s diverticulum – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/zenkers-diverticulum/diagnosis-treatment/drc-20568846

  Repairing Zenker’s diverticulum sometimes may need to be done in an open surgery, sometimes called an open repair. Before the procedure, you’re given general anesthesia. The ENT specialist makes a cut, called an incision, in the neck to remove the bulge. […] This surgery most often takes 2 to 3 hours. People who have this type of surgery often stay in the hospital for one or more days. This surgery eases symptoms for most people. […] Both endoscopic and open surgery ease Zenker’s diverticulum symptoms for most people. Endoscope procedures most often have shorter surgery times. Hospital stays often are just one night for endoscopic and open surgeries. […] If the first procedure doesn’t ease symptoms or if Zenker’s diverticulum comes back, you may need another procedure. And if Zenker’s diverticulum comes back, it often has no symptoms. Researchers study newer ways of fixing the condition.

• #17 Zenker’s Diverticulum Repair | Atrium Health Wake Forest Baptist

  https://www.wakehealth.edu/treatment/z/zenkers-diverticulum-repair

  Zenkers Diverticulum repair involves two surgical options to repair a pouch that forms in the muscular wall in the esophagus. […] The surgery to repair this pouch is either done on the inside through your mouth (endoscopic) or through an incision in your neck (open). […] Most patients prefer the endoscopic approach because the procedure and the recovery is usually shorter. […] The endoscopic surgery is a less invasive procedure that is performed by accessing the ZD with instrument placed through the mouth. […] Because the endoscopic approach is minimally invasive, patients often go home same day after surgery. […] If patients do not have adequate jaw opening or neck range of motion, they may need an open repair of the ZD. […] Because this is a more invasive procedure, patients will need a longer recovery time. […] After surgery patients stay in the hospital for about three days for observation, and will have a temporary feeding tube placed through their nose.

• #18 Endoscopic Management of Zenker Diverticula – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/april-2017/endoscopic-management-of-zenker-diverticula/

  G&H What are the advantages and disadvantages associated with endoscopic management compared to open surgery? […] TB The main advantages of endoscopic management, whether rigid or flexible, are the shorter recovery times and lower risk of adverse events that accompany open surgery, such as wound infection, hematoma, injury to the laryngeal nerve, and vocal cord paralysis. […] G&H Is anesthesia required for the management of Zenker diverticula? […] TB Patients undergoing the open surgical or rigid endoscopic approach require general anesthesia. It is not required for patients undergoing flexible endoscopic therapy; however, I have changed my practice such that all of my patients receive general anesthesia. […] G&H What other adverse events are associated with endoscopic management? […] TB The main concern with endoscopic management is perforation, which is usually recognized during the procedure and can usually be closed with through-the-scope clips.

• #18 Endoscopic Management of Zenker Diverticula – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/april-2017/endoscopic-management-of-zenker-diverticula/

  G&H Are there any patients in whom these approaches are contraindicated? […] TB Any patient who is not a candidate for sedation or who has a bleeding disorder that cannot be controlled should not undergo treatment. […] G&H Is endoscopic management likely to replace surgery as the primary treatment option? […] TB Certainly outside of the United States, flexible endoscopic management has been accepted as primary therapy, and it is gaining traction as a primary option in the United States. […] G&H What are the priorities of research in this field? […] TB Moving forward, it would be helpful to either try to standardize approaches or continue to refine the instruments for flexible endoscopic treatment.

• #19 Are there alternatives to surgery for Zenker diverticulum? | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/83/9/645

  In centers that do not offer flexible endoscopy, and for patients with a large diverticulum, open surgery is the sole option. It is done under general anesthesia with a left cervical approach. The length of the cricopharyngeal myotomy can vary from 2 to 6 cm. This is followed by one of three options: diverticulectomy, diverticulopexy, in which the diverticulum is repositioned and sutured against the prevertebral fascia, or diverticular inversion, in which the diverticulum is inverted into the esophageal lumen and then oversewn. Success rates for open surgery vary from study to study but are usually around 90%. Complications are reported in 10% to 30% of cases and include mediastinitis, severe recurrent laryngeal nerve injury, and a 1% to 2% chance of death. These rates seem high, but the older age of most of these patients puts them at high risk.

• #19 Are there alternatives to surgery for Zenker diverticulum? | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/83/9/645

  All endoscopic procedures involve incision of the wall separating the diverticulum from the esophageal lumen to relieve the obstruction. […] Flexible endoscopy is the first-line therapy for most patients in many centers. With the flexible endoscope, the diverticulotomy and the cricopharyngeal myotomy can be performed in an outpatient endoscopy suite, and general anesthesia is not required. Initial studies of outcomes using these approaches have been promising, with substantial reduction in dysphagia, regurgitation, and chronic cough. Unfortunately, this technique is associated with a recurrence rate as high as 25%. However, repeat endoscopic therapy in patients with recurrence results in success rates similar to those for first-time treatment. […] We recommend flexible endoscopy for the initial treatment of Zenker diverticulum in most patients, but its availability is limited in the United States, as many practitioners do not have adequate experience with the technique. […] For a large diverticulum, we recommend an open cervical procedure involving excision of the diverticulum or a diverticulopexy for patients who are good surgical candidates.

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

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

  Historically, ZD was treated with open surgery (transcervical diverticulectomy, diverticulopexy or diverticular inversion) associated with a more or less extensive longitudinal myotomy of the cricopharyngeal muscle. […] 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%. […] In our 15-year experience (2004 to 2018) at the A. Gemelli hospital (Fondazione A. Gemelli IRCCS, Catholic University of Rome), we resected the diverticulum after positioning a vascular TA-30 surgical stapler, according to Orringers technique (16) in 41/45 (91%) patients.

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

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

  The main outcome of ZD surgical treatment is the resolution of symptoms, in particular of dysphagia. […] 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. […] For big diverticula o redo-surgery after endoscopic failure, open surgery still remains the first choice.

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

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

  Zenker diverticulum, a pulsion diverticulum of the hypopharynx, is a rare lesion that occurs in elderly populations. The condition results in a classic presentation of symptoms, with complications that include aspiration and pneumonia, and is managed by endoscopic and open transcervical surgical repair. […] Botulinum toxin may be used to provide temporary relief of dysphagia symptoms. Symptomatic patients who are poor surgical risks and have small Zenker diverticula may be treated satisfactorily by this method. […] Surgical approaches include the following: Diverticulum invagination or imbrication with cricopharyngeal (CP) myotomy, Stapled or hand-sewn diverticulectomy with CP myotomy, Stapled or hand-sewn diverticulopexy with CP myotomy, Endoscopic division of the diverticular wall with an endoscopic stapler, Endoscopic division of the diverticular wall with a CO2 laser or other cutting tool.

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

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

  Zenker diverticula require intervention only if they produce symptoms. In general, small (ie, 2 cm) lesions found incidentally require no intervention. However, some surgeons contend that because these lesions are likely to become larger with time, intervention ought to be considered in younger, healthier, asymptomatic patients with Zenker diverticula. […] Small lesions are satisfactorily treated with a CP myotomy with or without an invagination procedure. Intermediate and large diverticula (ie, 2-6 cm) are best managed with open diverticulectomy with CP myotomy or by endoscopic diverticulotomy. Very large diverticula (ie, 6 cm) are best managed with excision with CP myotomy or a diverticulopexy with CP myotomy, depending on the health of the patient. […] Indications for the repair of Zenker diverticulum are broad. The diverticulum can frequently be the etiology for aspiration and pneumonia and should therefore be repaired in patients capable of tolerating the operative procedure.

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

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

  Rigid endoscopy generally has the same indications and contraindications as open surgical approaches; however, flexible endoscopy has the benefit of being able to be performed under deep sedation or on those with limited cervical mobility. […] Given this large array of treatment modalities, there has been little consensus on the technical aspects of how the operation should be carried out.

• #24 Zenker’s Diverticulum – Head & Neck Surgery | UCLA Health

  https://www.uclahealth.org/medical-services/head-neck-surgery/conditions-treated/zenkers-diverticulum

  Contemporary treatment of Zenker’s diverticulum involves an „endoscopic approach” and division of the common party wall between the esophagus and diverticulum. Endoscopic approach refers to the approach to the diverticulum through the mouth. An „open approach”, where an incision is made on the neck to expose and remove the diverticulum is rarely necessary. […] The success of the endoscopic approach is highly dependent on the experience of the surgeon. […] Endoscopic surgery generally leads to a shorter hospital stay and an earlier time to resuming food by mouth. In addition, laser surgery is able to completely divide more of the common party wall as compared to the endoscopic stapling techniques. […] The goal is to divide the party wall and perform a diverticulotomy; Zenker’s sac persists (NOT resected) but food is now able to drain into the esophagus without collecting in the pouch. […] The UCLA Swallowing Disorders Center is at the forefront of diagnosis and surgical treatment of Zenker’s Diverticulum.

• #25 OBM Geriatrics | Surgical Treatment of Zenker’s Diverticulum in Older Patients

  https://www.lidsen.com/journals/geriatrics/geriatrics-05-03-179

  Zenkers diverticulum is a cause of benign dysphagia. Surgical treatment is recommended for symptomatic patients. The methods of treatment include endoscopic and open transcervical techniques. All patients underwent a transcervical diverticulum resection with a myotomy of the cricopharyngeal muscle for a minimum length of 3 cm. The traditional open technique of treating cervical diverticula of the esophagus is safe for older patients, has an acceptable percentage of postoperative comorbidity, and yields good functional results. One of the surgical treatment options is the classical technique of diverticular resection, diverticulopexy, or plication with or without myotomy. Another management method is endoscopic treatment, which consists of Z-POEM and transection of the septum between the diverticulum and the esophagus using a stapler (mechanical sutures), a laser, or an ultrasonic scalpel. Surgical treatment of older patients is always challenging for the treating team. The primary indication for surgical treatment was dysphagia, which prevented oral feeding and was assessed before and after surgery based on a four-grade scale. The patients were qualified for classic transcervical diverticulum resection. A myotomy was initiated by transecting the cricopharyngeal muscle below the lower part of the resected diverticulum, which was extended to the muscular layer of the esophagus for a section of at least 3 cm. A very good score was achieved for 27 patients (71.05%), a good score for eight (21.05%), and a bad score for three (7.89%) patients. Surgical treatment outcomes are influenced by the knowledge of the pharyngolaryngeal anatomy, a precise surgical diverticular dissection, and myotomy. The surgical approach is associated with relatively low rates of complications, which are estimated to be approximately 10.5% on average, although the values range widely (from 0% to 46%) in the literature. The outcomes of open surgical treatment are very good, and the level of satisfaction following this intervention among patients ranges from 70% to 100%. Open surgical treatment is comparable to the endoscopic approach. The open surgical treatment of diverticula is a method of choice in patients with a recurrent diverticulum following endoscopic failure. Open surgery is one of the primary methods for treating the cervical diverticula of the esophagus. It is becoming less important due to advances in endoscopic techniques that have lower rates of complications-though they, unfortunately, have higher rates of recurrence.

• #26 Zenker’s diverticulum: Symptoms, causes, and surgery

  https://www.medicalnewstoday.com/articles/zenker-diverticulum

  Depending on the severity of ZD symptoms, treatment options may include dietary changes or surgery. […] For those with symptoms, treatment options may vary according to the severity of the diverticulum and its associated symptoms. […] Some treatment options include the below. […] If a person experiences difficulty swallowing, their doctor may recommend injections of botulinum toxin, which people know as Botox, to improve their swallowing function. […] Surgery may be necessary if a ZD is large and a person is experiencing symptoms. […] A surgeon may perform one of two types of surgery for ZD: open or endoscopic surgery. […] If a ZD is large or the person has a shorter neck or obesity, a doctor will usually recommend open surgery. […] During open surgery, a surgeon makes a small cut in the neck to remove the diverticulum or tack it upside down to stop it from collecting food.

• #27 Zenker’s Diverticulum | Speech and Health Library

  https://www.mtavspeechtherapy.com/zenkers-diverticulum

  Treatment for Zenkers Diverticulum depends on the severity of symptoms and the size of the diverticulum. Mild cases may be managed with dietary changes and speech therapy to improve swallowing techniques, while more severe cases often require surgical intervention. […] Endoscopic surgery is a minimally invasive procedure in which a surgeon cuts the tissue between the esophagus and the diverticulum to relieve symptoms. […] Open surgery may be required to remove or reduce the diverticulum in more severe cases. […] Speech therapy can help patients improve swallowing techniques and manage dysphagia through targeted exercises and strategies. […] Endoscopic surgery is the most effective treatment for severe cases, but speech therapy can help manage mild symptoms by improving swallowing techniques. […] Yes, speech therapy can help improve swallowing function, particularly in mild cases or after surgical treatment to prevent complications like aspiration.

• #28 Zenker’s Diverticulum | Mount Sinai – New York

  https://www.mountsinai.org/locations/grabscheid-voice-swallowing-center/conditions/zenkers-diverticulum

  At The Grabscheid Voice and Swallowing Center, our interdisciplinary team of speech language pathologists and laryngologists are experienced in evaluation and management of patients with Zenker’s diverticulum. During your consultation, you will undergo complete swallow evaluation to determine which types of interventions will best help relieve your symptoms. Our speech language pathologists are adept in performing evaluations of swallowing and helping patients rehabilitate their swallowing without surgery if that is in the patient’s best interest. Our surgeons are also versed in the evaluation of swallowing and are highly experienced in all types of surgery for relief of symptoms in patients with Zenker’s diverticulum. […] Once the Zenker’s diverticulum is identified and it is determined that it is the cause of the swallowing difficulty, then treatment options can be considered. Surgery is the standard of treatment but, for older or infirmed patients, life style and dietary modifications can be considered.

• #29 Zenker’s Diverticulum Surgery – Larian, MD

  https://larianmd.com/areas-of-focus/head-neck/zenkers-diverticulum-surgery/

  The success rate of this procedure in improving swallowing to a functional level is more than 95%. […] Recovery from the endoscopic technique is relatively simple. Patients are discharged home the next morning and must follow a liquid diet for one week, then a soft diet for the second week, after which they are able to start a regular diet. […] The open technique is used only very rarely, in exceptional situations. An incision is made on the side of the neck, allowing the surgeon to access the diverticulum and the CP muscle. After the CP muscle is cut, the diverticulum is removed using a stapling device. […] By using the endoscopic technique Dr. Larian has not had to resort to using the open method since the early 2000s. Excision of Zenkers diverticulum is best performed by a surgeon who has extensive experience in treating voice and swallowing disorders. […] Treatment for this problem is to cut the CP so that it doesn’t get in the way of swallowing. This procedure is called a cricopharyngeus myotomy. […] A CP myotomy can be performed endoscopically with a laser in the same way that Zenkers surgery is performed.

• #30 Zenker’s Diverticulectomy Postop/After Care | Mount Sinai – New York

  https://www.mountsinai.org/locations/grabscheid-voice-swallowing-center/postop-instructions/zenkers-diverticulectomy

  Voice Use: In general you can speak when needed. Your voice will be hoarse or rough for 2 to 4 days. If it is not normal after this period, discuss it with your doctor on your first visit after surgery. […] Antibiotics: You may be prescribed antibiotics for 7 days depending on how the incisions close. Please take this as directed.

• #31 Zenker’s Diverticulum – ENT Clinic

  https://ent-surgery.com.au/head-and-neck/zenkers-diverticulum/

  Surgery for Zenkers Diverticulum is generally smooth and uncomplicated. […] The recovery period after surgery for a Zenkers Diverticulum is generally smooth and uncomplicated. […] A sore throat is common following this surgery and may last for 1 to 2 weeks. […] You may experience some nausea which should improve after 24 hours. […] Fluids are essential – start with ice cubes, sips of water or your favourite juice drink and then progress to at least 250mL of drink per hour until you are able to tolerate a soft diet. […] If eating and drinking causes pain or shortness of breath please contact your doctor immediately. […] Cold drinks, non-acidic juices, ice cream and ice blocks are tolerated better in the first 24 hours after surgery. […] You will receive prescriptions for pain medications, antibiotics and possibly medications for nausea if needed.

• #31 Zenker’s Diverticulum – ENT Clinic

  https://ent-surgery.com.au/head-and-neck/zenkers-diverticulum/

  You will need to take an anti-reflux medication such as Losec, Nexium or Pariet for the first six weeks. […] Rest with limited activity at home for 24 to 48 hours. […] If you have any problems, following your surgery, you should speak to your local doctor, who will arrange to contact your ENT Specialist.

• #32

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=acc0188

  A small diverticulum with no symptoms or mild symptoms may not need treatment. […] A larger diverticulum is usually treated with surgery. Endoscopic treatment instead of surgery may be an option. The endoscope is a thin tube with a light and camera on the end of it. It lets the surgeon see into the throat. […] After surgery you may need to stay in the hospital overnight or longer. If endoscopic treatment is used, you may be able to go home sooner. After you heal, you may need a follow-up barium swallow test. […] Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line (811 in most provinces and territories) if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

• #33 Zenker’s diverticulum – ENT Info

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

  Conventional open surgery has high success rate ranging from 80 to 100% but complication and mortality rates are reported to be as high as 30% and 3%, respectively. […] In those who had stapler-assisted surgery, immediate symptoms relief achieved in 94% to 100% of patients. The long-term symptoms recurrence rate ranges from zero to 47%. With low mortality rate of 0% to 1% and morbidity rate of 10% to 31%.

• #34 Endoscopic management of Zenker’s diverticulum

  https://www.ijgii.org/journal/view.html?doi=10.18528/ijgii200004

  Endoscopic treatment of symptomatic ZD has been established as a safe and effective treatment option with fewer morbidities as compared to surgery. […] The outcomes of FED are mainly dependent on the operators experience and the size of the diverticulum. These factors partly explain the wide range of reported clinical success which ranges from 60%100% in the published literature. […] The predictive factors for recurrence include large size of the diverticulum ( 50 mm) and a small septotomy length 25 mm. […] FED is a safe procedure and major adverse events are rare. […] The main drawback of conventional FED is high incidence of symptom recurrences on follow-up. In an attempt to improve the outcomes of FED, several new techniques have been evaluated recently. […] The proposed advantage of this technique is reduced chances of recurrence due to complete division of the septum. A recent multicenter, retrospective study reported the outcomes of Z-POEM in 75 patients with ZD.

• #35 Endoscopic treatment of Zenker Diverticulum (Pharyngeal Pouch) – The Dudley Group NHS Foundation Trust

  https://www.dgft.nhs.uk/services-and-wards/endoscopic-treatment-of-zenker-diverticulum-pharyngeal-pouch/

  This treatment has been proved to be effective in over 85 per cent of cases. It is associated with a shorter hospital stay and reduces patients discomfort after the procedure. Patients are also able to starting eating again 24 hours after this endoscopic treatment. Therefore, the overall benefit of treating Zenkers diverticulum with a flexible telescope is very high. […] Many of the patients having this procedure are those who have had a recurrence of symptoms after previous surgery or who could not be treated because they are not able to have a general anaesthetic. As we carry out this procedure with deep sedation, this allows us to offer this procedure to almost all patients. […] This procedure is considered safe; however, all procedures carry some risks. The most serious complication is perforation (a hole) at the site of the cut. If this is identified during the procedure, a clip is placed to secure it. […] You may require antibiotics to prevent infections. As in this procedure we have to cut the muscle, there is a two to three per cent risk of bleeding that can be secured with a clip during the procedure.

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