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Zenker's diverticulum: advancing beyond the tunnel.

Linda Y Zhang¹, Jose Nieto², Saowanee Ngamruengphong¹

¹Johns Hopkins Medical Institutions, Baltimore, Maryland.

Videogie : an Official Video Journal of the American Society for Gastrointestinal Endoscopy

|December 17, 2021

Summary

Zenker's diverticulum (ZD) treatment is evolving with endoscopic techniques like Zenker's peroral endoscopic myotomy (Z-POEM). These advanced methods offer improved outcomes for ZD and related esophageal conditions.

Keywords:

FECM, flexible endoscopic cricopharyngeal myotomy TTSC, through-the-scope clip Z-POEM, Zenker’s peroral endoscopic myotomy ZD, Zenker’s diverticulum

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Area of Science:

Gastroenterology
Minimally Invasive Surgery
Esophageal Disorders

Background:

Zenker's diverticulum (ZD) is linked to cricopharyngeus muscle dysfunction.
Traditional cricopharyngeal myotomy has high recurrence rates due to incomplete muscle division.

Purpose of the Study:

To summarize endoscopic treatment options for Zenker's diverticulum (ZD) and related esophageal conditions.
To present modifications and techniques for improved endoscopic management of ZD.

Main Methods:

Review of endoscopic treatment modalities for ZD, cricopharyngeal bar, and other esophageal diverticula.
Demonstration of Zenker's peroral endoscopic myotomy (Z-POEM) with an over-the-septum modification.
Presentation of a hybrid technique for cases with submucosal fibrosis and Z-POEM with mucosotomy for large ZD.

Main Results:

Zenker's peroral endoscopic myotomy (Z-POEM) allows direct visualization and confirmation of complete cricopharyngeal myotomy, potentially reducing recurrence.
Modifications like the over-the-septum technique and hybrid approach address challenges such as submucosal fibrosis and large diverticula.
Z-POEM with mucosotomy is proposed for large ZD to mitigate residual dysphagia.

Conclusions:

Endoscopic treatments for ZD and related conditions are advancing rapidly.
Tailoring endoscopic techniques to patient specifics enables safe and effective management of a wide range of esophageal disorders.