From the Research
The treatment for Zenker's diverticulum is primarily endoscopic diverticulotomy, specifically Zenker Per Oral Endoscopic Myotomy (ZPOEM), due to its less invasive nature, improved rates of morbidity, and quicker recovery times, as demonstrated in the most recent and highest quality study 1. The primary treatment options for symptomatic patients with Zenker's diverticulum include endoscopic diverticulotomy or open surgical diverticulectomy with cricopharyngeal myotomy.
- Endoscopic treatment involves cutting the muscle between the diverticulum and the esophagus (cricopharyngeal muscle), which is less invasive and has a shorter recovery time.
- This can be performed using flexible or rigid endoscopy with various cutting techniques including laser, stapling, or electrocautery.
- Open surgical approaches involve either removing the diverticulum completely (diverticulectomy) or suspending it (diverticulopexy), along with dividing the cricopharyngeal muscle.
- For elderly or high-risk patients with mild symptoms, conservative management may be appropriate, including dietary modifications (eating slowly, chewing thoroughly, avoiding certain foods), postural techniques during eating, and regular follow-up.
- Treatment is necessary because Zenker's diverticulum can cause progressive dysphagia, regurgitation, aspiration pneumonia, and malnutrition.
- The choice between endoscopic and open surgical approaches depends on the patient's age, comorbidities, diverticulum size, and local expertise, with endoscopic approaches generally preferred as first-line treatment when feasible, as supported by studies 2, 3.
- A study from 2007 2 demonstrated the safety and feasibility of endoscopic myotomy through a flexible endoscope, with complete relief of dysphagia reported by all patients after 1 month.
- Another study from 2023 1 highlighted the promising results of ZPOEM, with improved outcomes and low rates of clinical recurrence and adverse events, making it an excellent option for patients suffering from Zenker's diverticulum.