Third Space Endoscopy | September 2021-Technology Committee Update: Devices and Techniques for Flexible Endoscopic Management of Zenker's Diverticulum

Pdf Summary

Endoscopic techniques and devices have been developed for the treatment of Zenker's diverticulum (ZD), a pulsion-type pseudodiverticulum in the pharyngoesophagus. The two main endoscopic techniques are flexible endoscopic septal division (FESD) and submucosal tunneling endoscopic septum division (STESD) or peroral endoscopic myotomy for ZD. FESD involves incision and division of the entire septum, while STESD creates a submucosal tunnel to perform the myotomy. Both techniques have favorable outcomes compared to traditional open surgery or rigid endoscopy. <br /><br />A meta-analysis of studies on FESD reported a pooled clinical success rate of 91%, with a recurrence rate of 11%. Another meta-analysis on FESD using a needle knife technique reported a pooled adverse event rate of 13%, including perforation (7%) and bleeding (5%). STESD has shown promising results with a technical success rate of 97.3% and clinical success rate of 92%. The procedure time for STESD is approximately 52 minutes, with a hospital stay of 1.8 days. The adverse event rate for STESD is 6.7%, with 4 cases of perforation.<br /><br />There is a need for standardization in endoscopic endpoints, symptom scores, and adverse event reporting for ZD treatments. Further research is needed to compare different techniques and devices, establish treatment algorithms and guidelines, and define optimal training pathways. Financial considerations include the lack of specific codes for endoscopic ZD treatment and variability in reimbursement. <br /><br />Overall, endoscopic approaches offer effective and safe alternatives to traditional surgical or rigid endoscopic treatments for ZD. Future developments in third space endoscopy may further improve treatment options for ZD.

Meta Tag

Disease Zenkers Diverticulum

Disease Pharyngoesophageal Diverticulum

Instrument & Accessory Used Cutting Knives

Instrument & Accessory Used Through the Scope Clips (TTS Clips)

Organ & Anatomy Esophagus

Organ & Anatomy Hypopharynx

Procedure Z-POEM

Keywords

endoscopic techniques

Zenker's diverticulum

flexible endoscopic septal division

FESD

submucosal tunneling endoscopic septum division

STESD

peroral endoscopic myotomy

clinical success rate

adverse event rate

treatment algorithms