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At least 19 recordsLinked to original sources
PubMed2003

Current trends in management of Zenker diverticulum.

Zenker's diverticulum is a relatively common problem encountered by head and neck surgeons. Careful review of the available literature regarding its pathogenesis indicates that Zenker diverticulum likely occurs as a result of increased intrabolus pressures during swallowing secondary to cricopharyngeal spasm. Rational treatment for Zenker diverticulum therefore addresses cricopharyngeal spasm. The traditional approach to diagnosis and management of Zenker diverticulum has been based on standard techniques and principles. For example, diverticulectomy with concurrent cricopharyngeal myotomy is an acceptable form of treatment with a high success rate. However, recent advances in endoscopic stapling and carbon dioxide laser technologies have added new options to the therapeutic armament of the otolaryngologist. For appropriately selected patients, endoscopic staple-assisted diverticulostomy is a minimally invasive, safe, and effective procedure associated with shorter hospital stays, more rapid postoperative recovery, decreased time to resumption of oral intake, and high levels of patient satisfaction.

Humans↗
PubMed2000

[Squamous epithelial carcinoma in a Zenker diverticulum].

Zenker's diverticulum is a common anomaly in the elderly patient. Carcinoma in such a diverticulum is a rare but recognized complication of a posterior pharyngeal pulsion diverticulum. We present a case of a 67-year-old patient with a long-standing symptomatic Zenker's diverticulum. The diagnosis of the neoplasm was only achieved intraoperatively. The patient underwent a proximal esophageal resection with lymphadenectomy. Reconstruction was done with a microvascular free jejunal transplant. The postoperative course was uneventful. Wide oncologic surgical resection is the therapy of choice in cases of carcinoma in a Zenker's diverticulum.

Aged↗
PubMed1987

Carcinoma arising in posterior pharyngeal pulsion diverticulum (Zenker's diverticulum).

Carcinoma is a rare but recognized complication of posterior pharyngeal pulsion (Zenker's diverticulum). Such diverticula merit radiological and endoscopic examination before operation. Surgery is preferred to radiotherapy in the treatment of carcinoma, the choice of operation resting between one-stage diverticulectomy for cancer confined to the body of the sac and pharyngolaryngectomy for more extensive lesions.

Aged↗
PubMed1997

[Laser diverticulotomy in hypopharyngeal diverticulum (Zenker's diverticulum)].

From 1992 until 1995 the Ear, Nose and Throat Department at the National Hospital investigated 29 patients and completed treatment of 28 patients with a hypopharyngeal diverticulum. A myotomy of the cricopharyngeal muscle was performed endoscopically using CO2 laser. One patient developed mediastinitis as a result of perforation during initial hypopharyngoscopy. Most of the patients reported improvement of the dysphagia. The advantages of this method are a shortened stay in hospital and less morbidity. In addition, the operation can be performed in elderly patients with other complicating diseases. This paper describes the surgical technique and the results.

Adult↗
PubMed1998

Zenker diverticulum.

The surgical treatment of Zenker diverticulum relieves dysphagia, coughing, and aspiration in nearly all patients. An understanding of the physiological basis for cricopharyngeal myotomy and anatomical detail has contributed to the high success rate. Meticulous technique in this elderly patient group is essential to prevent complications.

Humans↗
PubMed2007

Squamous cell carcinoma and Zenker diverticulum.

Squamous cell carcinoma in a Zenker diverticulum is a very rare condition. We report a case of a patient with a Zenker carcinoma, who was primarily functionally inoperable and therefore received neoadjuvant radiochemotherapy before cardiac bypass surgery. After a complicated course with cardiogenic shock and myocardial infarction, a re-evaluation of functional risk analysis and the tumor situation revealed operability. Subsequently, partial hypopharyngectomy and partial cervical esophageal resection with lymphadenectomy was performed. Reconstruction of the gastrointestinal continuity was made by interposition of a free small bowel graft and microvascular anastomosis. The postoperative course showed a small anastomotic leakage of the hypopharyngeal-small bowel anastomosis, which was successfully treated conservatively.

Aged↗
PubMed2003

Carbon dioxide laser diverticulostomy: a new treatment for Zenker diverticulum.

In the United States, the traditional treatment for hypopharyngeal (Zenker) diverticulum has been single-stage transcutaneous diverticulectomy. Complications following this procedure include mediastinitis, vocal cord paralysis, esophageal stenosis, fistula, and recurrent or persistent diverticula. The development of endoscopic equipment has led to a new era of surgery for this condition. Magnification of anatomic landmarks allows for better precision during surgery and reduces both surgical procedure time and postoperative complications. Additional techniques, such as diathermy, bipolar coagulation, stapler, and laser surgery, all of which decrease intraoperative bleeding, lend further support to the procedure. In several randomized controlled clinical trials, endoscopic laser treatment of diverticulum has demonstrated the best results in terms of decreased morbidity and fewer complications. Thus, laser approaches for treating Zenker diverticulum deserve consideration.

Carbon Dioxide↗
PubMed2003

Endoscopic management of Zenker diverticulum: the staple-assisted approach.

Hypopharyngeal (Zenker) diverticulum is a physiologic obstruction of the esophageal entroitus due, at least in part, to reflux irritation. Endoscopic techniques have largely replaced the traditional treatment, comprising external excision and myotomy. In this article, the classic Dohlman technique is compared with the newer endoscopic staple-assisted esophagodiverticulostomy, which provides an endoscopic approach to Zenker diverticulum-associated dysphasia. This technique can be practiced with a simulator, requires little experience, has a good safety record, and has acceptable results.

Esophagoscopy↗
PubMed2003

Association between Zenker diverticulum and gastroesophageal reflux disease: development of a working hypothesis.

A cause-and-effect relation between gastroesophageal reflux disease and Zenker diverticulum remains unclear. Convincing evidence exists demonstrating that patients with Zenker diverticula have increased resting tone of the cricopharyngeus muscle, and that this may be an important initiating factor for the development of Zenker diverticula. Yet some patients with cricopharyngeus hypertonicity never develop Zenker diverticulum. In this context, we hypothesize that acid-induced esophageal shortening may be an important cofactor. We suggest that acid reflux induces longitudinal esophageal shortening, which in turn increases the risk for the development of herniation between 2 spatially related structures, the pharyngeal constrictors and cricopharyngeus muscles, leading to the development of Zenker diverticulum. This hypothesis awaits clinical verification.

Gastroesophageal Reflux↗
PubMedDate not supplied

Cricopharyngeus myotomy as the only treatment for Zenker diverticulum.

Cricopharyngeal dysfunction, one of the most common causes of pharyngeal dysphagia, exhibits a variety of manifestations, one of which is Zenker diverticulum. This paper examines the physiology of swallowing, pathophysiology of its aberrations, and various methods of treating Zenker diverticulum. It is our purpose to emphasize cricopharyngeus (CP) myotomy as the only needed treatment for this diverticulum. Even in its advanced stages, excision of the diverticulum is a needless surgical exercise. Seven cases of Zenker diverticulum are reported in elderly patients; one of them had an excision of the diverticulum prior to presentation. Some were either completely obstructed or aspirating on esophagram. Cricopharyngeus myotomy, the only treatment provided, proved to be safe and effective without morbidity or fatalities. Patients' ability to eat orally was restored on the night of or the morning after surgery. No Levin tube is necessary and there is no risk of suture line leakage after the conventional diverticulectomy and CP myotomy. Hospital stay is greatly reduced and there is no risk of structure formation. In contrast to endoscopic division of CP muscle, there is no risk of mediastinitis because there is no break through the mucosa.

Aged↗
PubMed2002

Endoscopic stapling technique for the treatment of Zenker diverticulum vs standard open-neck technique: a direct comparison and charge analysis.

BACKGROUND: Presently, the 2 most widely used methods for the treatment of Zenker diverticulum are endoscopic stapling of the common party wall between the diverticulum sac and the esophagus and the standard open-neck technique involving diverticulectomy and cricopharyngeal myotomy. OBJECTIVE: To perform an analysis of the hospital charges to determine the economic efficiency of each technique based on our experience at the Mt Sinai Medical Center, New York, NY. METHODS: A retrospective analysis of 16 patients diagnosed as having Zenker diverticulum was conducted. Eight randomly chosen patients underwent endoscopic stapling with an EndoGIA 35-mm endoscopic stapler (Ethicon Inc, Somerville, NJ), and 8 randomly chosen patients underwent a standard open approach with diverticulectomy. Medical records were reviewed to determine operative time, length of hospital stay, time to oral intake, and postoperative complications. A charge analysis of the operative and postoperative fees was also performed. Statistical analysis between the 2 groups was conducted using analysis of variance and the paired t test. RESULTS: The mean +/- SD operative time for the endoscopic stapling technique was 25.5 +/- 15.78 minutes, which was significantly less (P<.001) than that for the open procedure, 87.6 +/- 35.10 minutes. The mean operative charges were roughly equivalent at US$ 5178 for the endoscopic procedure and US$ 5113 for the open procedure. The endoscopic procedure, while shorter in operative time, had the added expense of specialized equipment, specifically the EndoGIA endoscopic stapler. The mean +/- SD length of hospital stay for the endoscopic procedure was significantly shorter (P<.001) at 1.3 +/- 0.59 days vs 5.2 +/- 1.03 days for the open procedure. The inpatient hospital charges for the endoscopic group was also significantly less (P<.001) at a mean of US$ 3589 per stay vs US$ 11,439 for the open group. The mean +/- SD time to oral intake was significantly shorter (<.001) at a mean of US$ 3589 per stay vs US$ 11,439 for the open group. The mean +/- SD time to oral intake was significantly shorter (P<.001) in the endoscopic group at 0.8 +/- 0.26 days vs 5.1 +/- 1.25 days for the open group. There were no major complications in either group, and all patients experienced resolution of preoperative symptoms. CONCLUSIONS: Compared with the standard open technique, the endoscopic stapling technique for the treatment of Zenker diverticulum results in a statistically significant shorter operative time, hospital stay, and time to resume oral feedings. While the charges of the operative procedures were roughly equivalent, the total hospital charges were significantly less for the patients treated endoscopically.

Aged↗
PubMedDate not supplied

Pharyngo-oesophageal diverticulum (Zenker's). Clinical, therapeutic and morphological aspects.

In a series of 100 surgically treated patients, Zenker's diverticulum (ZD) appeared mostly as a typical geriatric disorder (50% over 70 years) in which not only oesophageal symptoms but also pulmonary symptoms (37%) may lead to a life-threatening situation. In 60% of the patients, associated upper gastrointestinal pathology was observed, most frequently being gastro-oesophageal reflux (30 patients). In 30% of the manometric studies of the oesophageal body and lower oesophageal sphincter, clear pathological patterns were observed. Morphological examinations, enzymohistochemistry, immunohistochemistry showed clear pathological changes not only at the level of the cricopharyngeal muscle but also at the level of the striated muscles of the cervical oesophagus. These clinical, manometric and morphological changes suggest that ZD is one expression of a more complex neurogenic disorder. They also justify the extramucosal myotomy of the cricopharyngeal wall and the striated muscle wall of the cervical oesophagus as well, as the cardinal step of operation. This myotomy was combined with a diverticulopexy resulting in no post-operative mortality and a minimum of morbidity. The mean longterm follow-up in this series is 4 years, showing excellent and very good results in 96% of the patients for the oesophageal symptoms and in 92% for the full spectrum of oesophageal and pulmonary symptomatology. With this single step operation, no recurrence has been seen seen as opposed to the endoscopic procedure.

Adult↗
PubMed1992

Manometric aspects of Zenker's diverticulum.

Zenker's diverticulum is thought to result from disordered coordination between the pharynx and upper esophageal sphincter. Manometric studies of the upper esophagus have been helpful in testing the hypothesis of dysmotility in the formation and growth of a Zenker's diverticulum; however, the data have provided conflicting evidence. Manometric studies show that resting upper esophageal sphincter pressure is normal in some patients with Zenker's diverticulum and decreased in others. Abnormal premature relaxation and contraction of the upper esophageal sphincter seen in some patients with Zenker's diverticulum may be accompanied by pharnygeal contractions against a closed sphincter. This abnormality is thought by some investigators to be the cause of Zenker's diverticulum, but not by others who have found normal upper sphincter relaxation. Future manometric studies will very likely elucidate the pathogenesis of Zenker's diverticulum.

Esophageal Diseases↗
PubMedDate not supplied

Zenker's diverticulum.

Zenker's diverticulum is a pouch protruding posteriorly above the upper esophageal sphincter, in the Killian's triangle, an area of relative weakness. Zenker's diverticulum was thought, for many years, to occur as a result of cricopharyngeal incoordination but more recent evidence points to poor upper sphincter compliance with diminished sphincter opening and increased hypopharyngeal pressures. Small Zenker's diverticula may be asymptomatic. As they become larger, symptoms include dysphagia, food regurgitation, and a sensation of globus. The best diagnostic method is a barium swallow with attention to the cricopharyngeal area. Although gastroesophageal reflux may be responsible for many throat symptoms, the relationship of reflux to the pathogenesis of Zenker's diverticulum is speculative. The treatment of Zenker's diverticulum is surgical. There have been many variations in technique over the years. Diverticulectomy with cricopharyngeal myotomy remains the most frequently performed operation. Endoscopic treatment with or without laser stapling has been reported but is not popular in the United States.

Humans↗
PubMed2004

[Endoscopic stapling diverticulostomy for Zenker diverticulum].

INTRODUCTION: The authors have successfully applied the endoscopic stapling diverticulostomy for three patients with symptomatic Zenker diverticulum. METHOD: Under light general anesthesia the hypopharynx was explored with a rigid, double lipped laryngoscope (Weerda, Storz). The common wall between the esophagus and and diverticulum was cut across and reunited with a endosurgical stapler. RESULTS: Operating time was 25 minutes in average. There were no intraoperative or postoperative complications. The oral feeding was started on the 2. postoperative day. The patients were symptom-free and they were discharged on the fifth postoperative day. The preoperative symptoms were not reported at follow-up assessment. CONCLUSION: The endoscopic stapler diverticulostomy offers distinct advantages, including brief operative time, short hospitalization, reduced morbidity, early oral feeding and predictable resolution of symptoms. The authors proposed the technique in the treatment of the patients with Zenker's diverticulum especially for elderly cases with diverticulum larger than 3 cm.

Aged↗
PubMed2005

[Endoscopic assisted endoluminal stapler-diverticulotomy of Zenker diverticulum].

INTRODUCTION: One of the advantages of endoluminal diverticolotomy in Zenker's diverticulum with the staple is the possibility of early rehabilitation. As the stapler allows to close the cut wound margins of the diverticulum threshold simultaneously with a clip suture, the patient can start oral food intake as early as 24 hours after surgery. The overview for the surgeon for correct placement of the clip device is limited due to the physiological narrowness of the pharyngeal tube. PATIENTS AND METHODS: We reduced the danger of malplacement by placing a temporary stomach tube as well as endoscopic control of the position of the stapler at the diverticulum threshold. RESULTS: 61 patients with Zenker's diverticulum stage Brombart I - IV have been successfully treated with this surgery technique since 1998. In two other patients a transcervical diverticulotomy was done because the diverticulum threshold could not be exposed clearly with the spread laryngoscope. In 10 patients a clinically symptomatical recurrent diverticulum (Brombart stage II) could be safely removed by a repeated endoscopically assisted stapler diverticulotomy. CONCLUSION: The advanced endoscopically assisted endoluminal stapler diverticulotomy in Zenker's diverticulum is convenient for the patient allowing prompt food intake and showing low morbidity and no mortality.

Adult↗