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World J Gastrointest Endosc. Feb 16, 2015; 7(2): 87-93
Published online Feb 16, 2015. doi: 10.4253/wjge.v7.i2.87
Current status of minimally invasive endoscopic management for Zenker diverticulum
Alberto Aiolfi, Federica Scolari, Greta Saino, Luigi Bonavina
Alberto Aiolfi, Federica Scolari, Greta Saino, Luigi Bonavina, Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, 20097 San Donato Milanese, Milan, Italy
Author contributions: All the authors contributed to this work.
Conflict-of-interest: The authors declare that they have no competing interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Luigi Bonavina, Professor, Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Piazza E. Malan 2, 20097 San Donato Milanese, Milan, Italy. luigi.bonavina@unimi.it
Telephone: +39-2-52774621 Fax: +39-2-52774395
Received: July 29, 2014
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
Abstract

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.

Keywords: Zenker diverticulum, Endoscopic stapling, Cricopharyngeal myotomy, Diverticulectomy, Interventional flexible endoscopy

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.