Flexible Endoscopic Treatment of Zenker's Diverticulum: A Center Experience and Literature Review

Abstract

Zenker's pharyngo-oesophageal diverticulum is a rare acquired hernia of the posterior mucosa at the pharyngo-oesophageal junction. The pathophysiology of this condition is still poorly understood. Our article aims to shed light on the epidemiological, clinical, paraclinical and therapeutic aspects of this pathology. By adopting a retrospective study, we followed 3 patients with Zenker's diverticulum, between January 2019 and December 2022, in our department of Hepato-gastro-enterology. They were 3 men aged 58, 54 and 90 years with a median age of 67.3 years. The clinical symptoms observed were dominated by upper dysphagia and regurgitation in all cases (100%). One patient had also weight loss as a complication (33%). The endoscopic examination combined with the cervico-thoracic CT scan allowed the diagnosis in all our patients (100%), with an average size of 3.5 cm (1.5-4 cm) for the diverticulum. The treatment adopted for our 3 patients was endoscopic diverticulotomy performed with a diverticuloscope. . The procedure duration was 35+/- 5 minutes with simple aftercare. The patients resumed oral feeding the next day, despite minimal postoperative pain. The median hospitalisation duration was 2 days and the average follow-up time was 12 months. Clinical success was 100% and no complications were noted. In conclusion, endoscopic diverticulotomy is an effective treatment to quickly improve symptoms while reducing hospitalization length and complications risk, especially in elderly patients with comorbidities.