Background and Aims
Zenker’s diverticulum (ZD) has traditionally been treated with open surgery or rigid
endoscopy. With the advances in endoscopy, alternative flexible endoscopic treatments
have been developed.
Methods
This document reviews current endoscopic techniques and devices used to treat ZD.
Results
The endoscopic techniques may be categorized as the traditional flexible endoscopic
septal division and the more recent submucosal tunneling endoscopic septum division,
also known as peroral endoscopic myotomy for ZD. This document also addresses clinical
outcomes, safety, and financial considerations.
Conclusions
Flexible endoscopic approaches treat symptomatic ZD with results that are favorable
compared with traditional open surgical or rigid endoscopic alternatives.
Abbreviations:
AE (adverse event), ASGE (American Society for Gastrointestinal Endoscopy), CP (cricopharyngeal), ESD (endoscopic submucosal dissection), FESD (flexible endoscopic septal division), POEM (peroral endoscopic myotomy), STESD (submucosal tunneling endoscopic septum division), TTS (through-the-scope), ZD (Zenker’s diverticulum), Z-POEM (peroral endoscopic myotomy for Zenker’s diverticulum)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Zenker’s diverticulum: exploring treatment options.Acta Otorhinolaryngol Ital. 2013; 33: 219-229
- Zenker’s diverticulum: reappraisal.Am J Gastroenterol. 1996; 91: 1494-1498
- Zenker’s diverticulum: flexible versus rigid repair.J Thorac Dis. 2017; 9: S154-S162
- Pharyngeal diverticula; observations on their evolution and treatment.Br J Surg. 1950; 38: 129-146
- Flexible endoscopic treatment of Zenker’s diverticulum: a new approach.Endoscopy. 1995; 27: 438-442
- The SWAL-QOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia in adults. III. Documentation of reliability and validity.Dysphagia. 2002; 17: 97-114
- Changes in swallowing-related quality of life after endoscopic treatment for Zenker’s diverticulum using SWAL-QOL questionnaire.Dysphagia. 2017; 32: 339-344
- Validity and reliability of the Eating Assessment Tool (EAT-10).Ann Otol Rhinol Laryngol. 2008; 117: 919-924
- Flexible endoscopic treatment for Zenker’s diverticulum: a systematic review and meta-analysis.Gastrointest Endosc. 2016; 83: 1076-1089
- Endoscopic treatment of Zenker’s diverticulum.Gastrointest Endosc. 1999; 49: 93-97
- Flexible endoscopic Zenker’s diverticulotomy: cap-assisted technique vs. diverticuloscope-assisted technique.Endoscopy. 2007; 39: 146-152
- Endotherapy of Zenker’s diverticulum using the needle-knife technique: long-term follow-up.Endoscopy. 2007; 39: 131-136
- Endoscopic treatment of Zenker diverticulum: results of a 7-year experience.J Am Coll Surg. 2010; 211: 239-243
- Endoscopic treatment for Zenker’s diverticulum: long-term results (with video).Gastrointest Endosc. 2013; 77: 701-707
- Alternative endoscopic treatment of Zenker’s diverticulum: a case series (with video).Gastrointest Endosc. 2014; 79: 168-170
- Prognostic variables for the clinical success of flexible endoscopic septotomy of Zenker’s diverticulum.Gastrointest Endosc. 2016; 83: 765-773
- Endoscopic submucosal dissection.Gastrointest Endosc. 2015; 81: 1311-1325
- Enteral nutrition access devices.Gastrointest Endosc. 2010; 72: 236-248
- Endoscopic flexible treatment of Zenker’s diverticulum: a modification of the needle-knife technique.Endoscopy. 2010; 42: 532-535
- Usefulness of the hook knife in flexible endoscopic myotomy for Zenker’s diverticulum.World J Gastrointest Endosc. 2017; 16: 411-416
- Interest of submucosal dissection knife for endoscopic treatment of Zenker’s diverticulum.Surg Endosc. 2015; 29: 2802-2810
- Treatment of Zenker’s diverticulum through a flexible endoscope with a transparent oblique-end hood attached to the tip and a monopolar forceps.Endoscopy. 2007; 39: 137-140
- Flexible endoscopic treatment for Zenker’s diverticulum with the SB Knife. Preliminary results from a single-center experience.Dig Endosc. 2015; 27: 728-733
- The role of flexible endotherapy for the treatment of recurrent Zenker’s diverticula after surgery and endoscopic stapling.Surg Endosc. 2016; 30: 2351-2357
- Endoscopic treatment of Zenker’s diverticulum with the stag beetle knife (sb knife): feasibility and follow-up.Scand J Gastroenterol. 2016; 51: 1155-1158
- Endoscopic retreatment of Zenker’s diverticulum using novel endoscopic scissors—the Clutch Cutter device.Rev Esp Enferm Dig. 2017; 109: 669
- New flexible endoscopic controlled stapler technique for the treatment of Zenker’s diverticulum: a case series.World J Gastroenterol. 2017; 23: 3084-3091
- Flexible endoscopic Zenkers diverticulotomy with a novel bipolar forceps: a pilot study and comparison with needleknife dissection.Surg Endosc. 2011; 25: 3273-3278
- Endoscopic diverticulotomy using LigasureTM.Gastroenterol Hepatol. 2017; 40: 80-84
- Electrosurgical generators.Gastrointest Endosc. 2013; 78: 197-208
- Per-oral endoscopic myotomy (with video).Gastrointest Endosc. 2016; 83: 1051-1060
- Endoscopic closure devices.Gastrointest Endosc. 2012; 76: 244-251
- Novel technique for flexible endoscopic repair of Zenker’s diverticulum.VideoGIE. 2016; 1: 51-52
- Clinical relevance and prognostic value of radiographic findings in Zenker’s diverticulum.Eur Arch Otorhinolaryngol. 2014; 271: 583-588
- Double incision and snare resection in symptomatic Zenker’s diverticulum: a modification of the stag-beetle knife technique.Endoscopy. 2018; 50: 182
- Double incision and snare resection in symptomatic Zenker’s diverticulum: a modification of the stag beetle knife technique.Endoscopy. 2018; 50: 137-141
- Endoscopic needle-knife treatment for symptomatic esophageal Zenker’s diverticulum: a meta-analysis and systematic review.J Dig Dis. 2018; 19: 204-214
- Comparison of flexible endoscopic cricopharyngeal myectomy and myotomy approaches for Zenker diverticulum repair.Gastrointest Endosc. 2019; 89: 880-886
- Double incision and snare: a new approach for flexible endoscopic treatment of Zenker’s diverticulum. Description of a new technique and preliminary results [abstract].Gut. 2015; 64: A60-A61
- Surgical treatment of Zenker’s diverticulum.Dig Surg. 2013; 30: 207-218
- Endoscopic versus surgical approach in the treatment of Zenker’s diverticulum: systematic review and meta-analysis.Endosc Int Open. 2016; 4: E678-E686
- Comparing outcomes of open vs flexible and rigid trans-oral endoscopic techniques for the treatment of Zenker’s diverticulum.J Am Coll Surg. 2014; 219: e67
- Submucosal per-oral endoscopic myotomy for a large Zenker’s diverticulum with use of a hydrodissector knife and an over-the-scope clip closure.VideoGIE. 2018; 3: 373-374
- Submucosal tunneling endoscopic septum division for Zenker’s diverticulum: a reproducible procedure for endoscopists who perform peroral endoscopic myotomy.Endoscopy. 2017; 49: 613-614
- Submucosal tunneling endoscopic septum division for treatment of Zenker’s diverticulum.Endoscopy. 2018; 50: E340-E341
- Zenker’s diverticulum: submucosal tunneling endoscopic septum division (Z-POEM).Dig Endosc. 2018; 30: 124
- Zenker’s diverticulum per-oral endoscopic myotomy techniques: changing paradigms.Gastroenterology. 2019; 156: 2134-2135
- Mucosotomy at the top of the septum facilitates tunneling and clipping during peroral endoscopic myotomy for Zenker’s diverticulum (Z-POEM).Ann Gastroenterol. 2020; 33: 101
- An international study on the use of peroral endoscopic myotomy in the management of Zenker’s diverticulum.Gastrointest Endosc. 2020; 91: 163-168
- An animal training model for endoscopic treatment of Zenker’s diverticulum.Gastrointest Endosc. 2007; 65: 1050-1053
Article info
Publication history
Published online: April 26, 2021
Accepted:
February 13,
2021
Received:
February 12,
2021
Footnotes
This document is from the American Society for Gastrointestinal Endoscopy Technology Committee and was reviewed and approved by the Governing Board of the American Society for Gastrointestinal Endoscopy.
The American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Evidence-based methods are used, with a MEDLINE literature search to identify pertinent clinical studies on the topic. This is supplemented by accessing the "related articles" feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but in many cases data from randomized controlled trials are lacking. In such cases, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. Technology Status Evaluation Reports are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the committee as a whole, and approved by the Governing Board of the ASGE. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. For this review the MEDLINE database was searched through March 2019 for articles related to endoscopic treatment of Zenker’s diverticulum by using keywords such as “endoscopy” or “endoscopic” combined with “Zenker” or “Zenker’s diverticulum,” among others. Technology Status Evaluation Reports are scientific reviews provided solely for educational and informational purposes. Technology Status Evaluation Reports are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment.
Identification
Copyright
© 2021 by the American Society for Gastrointestinal Endoscopy
