Published online Feb 16, 2015. doi: 10.4253/wjge.v7.i2.87
Peer-review started: July 30, 2014
First decision: October 31, 2014
Revised: November 2, 2014
Accepted: November 27, 2014
Article in press: December 1, 2014
Published online: February 16, 2015
Surgical resection has been the mainstay of treatment of pharyngoesophageal (Zenker) diverticula over the past century. Developments in minimally invasive surgery and new endoscopic devices have led to a paradigm change. The concept of dividing the septum between the esophagus and the pouch rather than resecting the pouch itself has been revisited during the last three decades and new technologies have been investigated to make the transoral operation safe and effective. The internal pharyngoesophageal myotomy accomplished through the transoral stapling approach has been shown to effectively relieve outflow obstruction and restore physiological bolus transit in patients with medium size diverticula. Transoral techniques, either through a rigid device or by flexible endoscopy, are gaining popularity over the open surgical approach due the low morbidity, the fast recovery time and the fact that the procedure can be safely repeated. We provide an analysis of the the current status of minimally invasive endoscopic management of Zenker diverticulum.
Core tip: Developments in minimally invasive surgery and interventional endoscopic techniques have led to profound changes in the management of Zenker’s diverticula. Transoral techniques, either through a rigid or flexible endoscopic device, have gained popularity due to the low morbidity, fast recovery time and safe repeatability. However, the choice of treatment is still based on phisician’s expertise, personal preferences, and area of specialty. Endostapling through rigid endoscopy remains the most frequently performed approach. Interventional flexible endoscopy is an attractive minimally-invasive treatment option. However, due to heterogeneity of data and lack of standardized protocols, a direct comparison of the various techniques is difficult. Prospective clinical studies are required to establish treatment guidelines for Zenker diverticulum.