Zenker's diverticulum: flexible versus rigid repair

Area of Science:

• Gastroenterology
• Surgical Endoscopy

Background:

• Zenker's diverticula (ZDs) are a common cause of cervical dysphagia.
• Treatment options include open, transcervical, and transoral approaches.
• Transoral approaches have largely replaced transcervical methods due to reduced pain and faster recovery.

Purpose of the Study:

• To evaluate the efficacy and safety of flexible endoscopic treatment for Zenker's diverticula.
• To compare flexible endoscopy with other treatment modalities for ZDs.

Main Methods:

• Review of diagnosis via upper GI exam and endoscopy.
• Comparison of transoral stapling (rigid) versus flexible endoscopic approaches.
• Focus on technique, visualization, and outcomes.

Main Results:

• Transoral stapling has drawbacks including difficult visualization and incomplete staple line.
• Flexible endoscopy allows direct vision, tailored myotomy, and potentially lower recurrence rates.
• Experienced endoscopists report high technical success and low complication rates with flexible endoscopy.

Conclusions:

• Flexible endoscopic treatment is the preferred initial approach for Zenker's diverticula.
• Open or rigid transoral approaches are reserved for specific indications.
• Flexible endoscopy offers comparable or superior success rates with improved patient outcomes.