Endoscopic Septotomy Is Safe and Effective for the Treatment of Zenker’s Diverticulum

Zenker’s diverticulum (ZD) can lead to dysphagia to both solids and liquids and can be treated endoscopically or surgically. This retrospective, single-center, observational study evaluated the short- and long-term outcomes of patients treated with flexible endoscopic septotomy (FES).  

This study followed 256 patients (186 males; mean age, 74.3 ± 11.6 years) referred for endoscopic treatment of symptomatic ZD, for which FES was deemed first-line therapy. All of the procedures were performed by the same expert endoscopist. Follow-up included assessment by phone call or clinic visit at 1 month postprocedure, followed by every 6 months for 2 years and then yearly until study close or a recurrence. 

The procedure was successfully completed in all patients. The mean duration of the procedure was 18.5 ± 5.2 minutes, and deep sedation with propofol was the anesthesia method for 92.2% of patients. More than half of the patients (52.3%) were discharged following the procedure, and those who were admitted were hospitalized for 1.6 ± 1.1 days. Early clinical success, defined as resolution of symptoms 1 month postprocedure, occurred in 96.8% of patients (248/256). Eighty patients (31.3%) had symptom recurrence within 65.1 ± 33.9 months. FES was repeated in 95% of patients (76/80), 89.5% of whom had no symptoms within 37.3 ± 11.7 months from the repeat FES. 

The adverse event (AE) rate was low at 3.5% (9/256), with 1 minor AE (severe pharyngodynia), 3 moderate AEs (dysphagia requiring endoscopy and removal of clips, aspiration pneumonia, and postprocedure bleeding), and 5 severe AEs (perforation). No patient deaths were reported.