Abstract
Objective
Zenker's diverticula occur primarily in older patients, resulting in dysphagia, aspiration, and weight loss. A number of surgical options are available for treatment. While small diverticula (smaller than 2 cm) may require no surgical treatment, the presence of dysphagia, asiration, may necessitate surgery. Surgical options include both traditional open and endoscopic procedures. Many patients are elderly and cannot undergo open surgical procedures. Endoscopic techniques have become the preferred approaches by physicians because of their safety, effectiveness, and fewer complications.
Methods
Retrospective chart review of 65 patients who underwent endoscopic carbon dioxide (CO2) laser treatment of Zenker's diverticulum at a single tertiary care institution. In some of the procedures, the incision was sealed with a tissue sealant.
Results
Age ranged from 56 to 89 years. All patients had significant improvement in their symptoms such as dysphagia, aspiration, and weight gain. The endoscopic incision was performed in 1 session using the CO2 laser and a microscope. 2 complications (cervical emphysema) were managed conservatively and 1 postoperative bleeding required return to the operating room. The endoscopic exposure was not achieved in 2 patients due to difficult exposure. There were no mortalities. Mean follow-up was 27 months. There was no recurrence of dysphagia and all patients remained asymptomatic.
Conclusions
CO2 laser endoscopic treatment of symptomatic Zenker's diverticulum is an effective and safe method. It is quick and simple, and permits a short hospital stay and quick return to activities. Tissue sealant provides additional safety and reduces the incidence of postoperative complications.
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