eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Bronchoesophagology

Zenker Diverticulum: Follow-up

Author: Joel A Ernster, MD, Active Staff, Penrose-St Francis Healthcare System; Active Staff, Memorial Health System; Clinical Instructor, University of Colorado Health Sciences Center
Contributor Information and Disclosures

Updated: Jan 17, 2008

Outcome and Prognosis

Diverticulectomy with cricopharyngeal myotomy

  • Advantages
    • Removes the diverticulum
    • Provides tissue for pathologic review
    • Highly effective
  • Disadvantages
    • Longer surgical intervention
    • Longer hospitalization
    • Delayed alimentation
  • Immediate symptom relief (90-100%)
  • Long-term symptom recurrence (2-33%): Gutschow compared the success rates with "open" versus endoscopic techniques.6 He found that in sacs that measured less than 3 cm the open technique achieved 98% long-term success while the endoscopic approach achieved only a 57% rate. With sacs larger than 3 cm, the success rate was 97% and 88%, respectively.

Endoscopic diverticulotomy with stapler

  • Advantages
    • Short surgical procedure
    • Easily repeated
    • Quick return to oral alimentation
    • Short hospitalization
    • Less tissue trauma
    • Highly effective
  • Disadvantages
    • Unable to perform in some patients
    • Does not remove the diverticulum
    • No tissue for pathologic review
  • Immediate symptom relief (94-100%)
  • Long-term symptom recurrence
    • Stapling technique (0-47%): According to Gutschow, the recurrence rate with any endoscopic approach is greater if the sac is smaller.6
    • Recurrences may be successfully managed with a repeat endoscopic or an "open" approach; when performing the open approach, the surgeon needs to recognize the altered anatomy present as a result of the prior endoscopic procedure.
  • Cautery or laser technique (1-79%; varies widely by reporting site)

Future and Controversies

A complete understanding of the etiology of Zenker diverticulum (ZD) formation is not available. Further studies focused on the function of the CP muscle are likely to be fruitful.

The procedure of choice for Zenker diverticula 2-4 cm in length (the most common size) is different for different surgeons. The final role for endoscopic procedures (with the laser or stapler) awaits further analysis and longer-term follow-up studies.

 


More on Zenker Diverticulum

Overview: Zenker Diverticulum
Workup: Zenker Diverticulum
Treatment: Zenker Diverticulum
Follow-up: Zenker Diverticulum
Multimedia: Zenker Diverticulum
References
[ CLOSE WINDOW ]

References

  1. Kern M, Bardan E, Arndorfer R, Hofmann C, Ren J, Shaker R. Comparison of upper esophageal sphincter opening in healthy asymptomatic young and elderly volunteers. Ann Otol Rhinol Laryngol. Oct 1999;108(10):982-9. [Medline].

  2. 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. Mar 1994;103(3):178-85. [Medline].

  3. Tsikoudas A, Eason D, Kara N, Brunton JN, Mountain RE. Correlation of radiologic findings and clinical outcome in pharyngeal pouch stapling. Ann Otol Rhinol Laryngol. Oct 2006;115(10):721-6. [Medline].

  4. Dohlman G. The endoscopic operation for hypopharyngeal diverticula. Arch Otolar. 1960;71:744-752.

  5. Collard JM, Otte JB, Kestens PJ. Endoscopic stapling technique of esophagodiverticulostomy for Zenker's diverticulum. Ann Thorac Surg. Sep 1993;56(3):573-6. [Medline].

  6. Gutschow CA, Hamoir M, Rombaux P, Otte JB, Goncette L, Collard JM. Management of pharyngoesophageal (Zenker's) diverticulum: which technique?. Ann Thorac Surg. Nov 2002;74(5):1677-82; discussion 1682-3. [Medline].

  7. Achkar E. Zenker's diverticulum. Dig Dis. May-Jun 1998;16(3):144-51. [Medline].

  8. Bonavina L, Bona D, Abraham M, Saino G, Abate E. Long-term results of endosurgical and open surgical approach for Zenker diverticulum. World J Gastroenterol. May 14 2007;13(18):2586-9. [Medline].

  9. Cook IJ. Cricopharyngeal function and dysfunction. Dysphagia. 1993;8(3):244-51. [Medline].

  10. Crescenzo DG, Trastek VF, Allen MS, Deschamps C, Pairolero PC. Zenker's diverticulum in the elderly: is operation justified?. Ann Thorac Surg. Aug 1998;66(2):347-50. [Medline].

  11. Feeley MA, Righi PD, Weisberger EC, Hamaker RC, Spahn TJ, Radpour S. Zenker's diverticulum: analysis of surgical complications from diverticulectomy and cricopharyngeal myotomy. Laryngoscope. Jun 1999;109(6):858-61. [Medline].

  12. Gross ND, Cohen JI, Andersen PE. Outpatient endoscopic Zenker diverticulotomy. Laryngoscope. Feb 2004;114(2):208-11. [Medline].

  13. Hadley JM, Ridley N, Djazaeri B, Glover G. The radiological appearances after the endoscopic crico-pharyngeal myotomy: Dohlman's procedure. Clin Radiol. Aug 1997;52(8):613-5. [Medline].

  14. Hoffmann M, Scheunemann D, Rudert HH, Maune S. Zenker's diverticulotomy with the carbon dioxide laser: perioperative management and long-term results. Ann Otol Rhinol Laryngol. Mar 2003;112(3):202-5. [Medline].

  15. Lippert BM, Folz BJ, Gottschlich S, Werner JA. Microendoscopic treatment of the hypopharyngeal diverticulum with the CO2 laser. Lasers Surg Med. 1997;20(4):394-401. [Medline].

  16. Miller FR, Bartley J, Otto RA. The endoscopic management of Zenker diverticulum: CO2 laser versus endoscopic stapling. Laryngoscope. Sep 2006;116(9):1608-11. [Medline].

  17. Narne S, Cutrone C, Bonavina L, Chella B, Peracchia A. Endoscopic diverticulotomy for the treatment of Zenker's diverticulum: results in 102 patients with staple-assisted endoscopy. Ann Otol Rhinol Laryngol. Aug 1999;108(8):810-5. [Medline].

  18. Paleri V, Najim O, Meikle D, Wilson JA. Microlaryngoscopic repair of iatrogenic pharyngeal pouch perforations: treatment of choice?. Head Neck. Feb 2007;29(2):189-92. [Medline].

  19. Palmer AD, Herrington HC, Rad IC, Cohen JI. Dysphagia after endoscopic repair of Zenker's diverticulum. Laryngoscope. Apr 2007;117(4):617-22. [Medline].

  20. Parker AJ, Hawthorne MR. Endoscopic diverticulotomy versus external diverticulectomy in the treatment of pharyngeal pouch. J R Coll Surg Edinb. Apr 1988;33(2):61-4. [Medline].

  21. Peracchia A, Bonavina L, Narne S, Segalin A, Antoniazzi L, Marotta G. Minimally invasive surgery for Zenker diverticulum: analysis of results in 95 consecutive patients. Arch Surg. Jul 1998;133(7):695-700. [Medline].

  22. Périé S, Dernis HP, Monceaux G, Angelard B, St Guily JL. The "sign of the rising tide" during swallowing fiberoscopy: a specific manifestation of Zenker's diverticulum. Ann Otol Rhinol Laryngol. Mar 1999;108(3):296-9. [Medline].

  23. Rabenstein T, May A, Michel J, Manner H, Pech O, Gossner L, et al. Argon plasma coagulation for flexible endoscopic Zenker's diverticulotomy. Endoscopy. Feb 2007;39(2):141-5. [Medline].

  24. Richardson BE, Bastian RW. Videoendoscopic swallowing study for diagnosis of Zenker's diverticuli. Laryngoscope. May 1998;108(5):721-4. [Medline].

  25. Saetti R, Silvestrini M, Peracchia A, Narne S. Endoscopic stapler-assisted Zenker's diverticulotomy: which is the best operative facility?. Head Neck. Dec 2006;28(12):1084-9. [Medline].

  26. Scher RL. Endoscopic staple diverticulostomy for recurrent Zenker's diverticulum. Laryngoscope. Jan 2003;113(1):63-7. [Medline].

  27. Scher RL, Richtsmeier WJ. Long-term experience with endoscopic staple-assisted esophagodiverticulostomy for Zenker's diverticulum. Laryngoscope. Feb 1998;108(2):200-5. [Medline].

  28. Spinelli P, Ballardini G. Botulinum toxin type A (Dysport) for the treatment of Zenker's diverticulum. Surg Endosc. Apr 2003;17(4):660. [Medline].

  29. Thorne M, Harris P, Marcus K, Teknos TN. Bilateral vocal fold paresis after endoscopic stapling diverticulotomy for Zenker's diverticulum. Head Neck. Mar 2004;26(3):294-7. [Medline].

  30. van Overbeek JJ. Microendoscopic CO2 laser surgery of the hypopharyngeal (Zenker's) diverticulum. Adv Otorhinolaryngol. 1995;49:140-3. [Medline].

  31. van Overbeek JJ. Pathogenesis and methods of treatment of Zenker's diverticulum. Ann Otol Rhinol Laryngol. Jul 2003;112(7):583-93. [Medline].

  32. Westrin KM, Ergün S, Carlsöö B. Zenker's diverticulum--a historical review and trends in therapy. Acta Otolaryngol. May 1996;116(3):351-60. [Medline].

  33. Zbären P, Schär P, Tschopp L, Becker M, Häusler R. Surgical treatment of Zenker's diverticulum: transcutaneous diverticulectomy versus microendoscopic myotomy of the cricopharyngeal muscle with CO2 laser. Otolaryngol Head Neck Surg. Oct 1999;121(4):482-7. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

Zenker diverticulum, pharyngeal diverticulum, ZD, Zenker diverticula, Killian triangle, cricopharyngeus muscle, CP muscle, diverticulectomy, open diverticulectomy, endoscopic diverticulectomy, CP myotomy, diverticulopexy, diverticulotomy

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Joel A Ernster, MD, Active Staff, Penrose-St Francis Healthcare System; Active Staff, Memorial Health System; Clinical Instructor, University of Colorado Health Sciences Center
Joel A Ernster, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Rhinologic Society, Colorado Medical Society, and Triological Society
Disclosure: Nothing to disclose.

Medical Editor

Lanny Garth Close, MD, Chair, Professor, Department of Otolaryngology-Head and Neck Surgery, Columbia University College of Physicians and Surgeons
Lanny Garth Close, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Physicians, American Laryngological Association, American Society for Head and Neck Surgery, and New York Academy of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Karen Hall Calhoun, MD, Chair, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Missouri
Karen Hall Calhoun, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Rhinologic Society, Society of University Otolaryngologists-Head and Neck Surgeons, and Texas Medical Association
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: UST Grant/research funds Consulting

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.