Introduction Zenker’s diverticulum, caused by dysfunction of the cricopharyngeal (CP) muscle, is a disease of the elderly causing dysphagia. Although rigid endoscopic CP myotomy is the treatment of choice, flexible endoscopic therapy is another technique available. It is performed under sedation without need for anaesthetic or neck extension, a key advantage in elderly patients with significant co-morbidity.
Methods We describe the first UK experience of endoscopic CP myotomy for Zenker’s diverticulum.
Results 4 patients (3 male) were referred, aged 74, 73, 60, 80 respectively, with proven Zenker’s diverticulum on barium radiology and characteristic symptomatology. Zenker length was 7.0, 4.0, 2.5, 2.5cm respectively. 2 patients were refused surgery due to cardiovascular co-morbidity, 1 due to limited neck extension with 1 case personal preference. The procedure was performed using propofol sedation. The muscle bridge was cut by hook knife electrocautery alone (3) or with Argon (1). A supplementary clip was applied post electrocautery in 1 case. All patients were observed for 24 hours for signs of perforation and then discharged. There were no complications.
At 4 weeks 3 patients had complete resolution of their symptoms, 1 with marked improvement. Follow up time to date 18.104.22.168 months respectively. There was no reported recurrence of symptoms.
Conclusion Diverticulotomy with a flexible endoscope is an effective treatment for Zenker’s diverticulum. It is a relatively simple yet under-utilised technique that avoids general anaesthesia in elderly/high-risk patients.
Disclosure of Interest None Declared
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