Zenker's Diverticulum and Psychosis in the Elderly

Abstract Background and study aims Zenker's diverticulum may cause disabling symptoms, especially in the elderly. Treatment has changed in recent decades from open surgery to management with flexible endoscopy, resulting in lower morbidity and mortality. The goal of this study was to present the largest series, with the longest follow-up, of patients with Zenker's diverticulum receiving outpatient treatment with flexible endoscopy using a diverticuloscope and Ligasure (Covidien, Minneapolis, Minnesota, United States), a device that allows tissue sealing and coagulation of vessels before cutting the septum between the diverticulum and esophagus. Patients and methods We performed 79 diverticulotomies in 69 patients (65.2 % male, mean age 73.4 years). The mean diverticulum size was 2.8 cm. In three cases with a diverticulum ≤ 1.5 cm, the diverticuloscope could not be placed. Results The technical success was 95.83 % and the clinical success 96.7 %: 84 % of the 56 patients followed for a mean of 34.6 months (24 – 64 months) had no dysphagia. The recurrence rate was 10.4 %, with a good response to a second diverticulotomy at 12 months (IQR: 11.5 – 17) in most cases. The most severe complications were two microperforations, resolved with conservative treatment, and one case of delayed bleeding endoscopically-controlled with a clip. Conclusions Diverticulotomy of the esophageal-diverticular septum with Ligasure is an outpatient endoscopic technique that is simple, effective in the long term and very safe for the treatment of patients with Zenker's diverticulum. In symptomatic recurrences, a second procedure was equally safe and effective in most patients.

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Treatment of type II odontoid fracture in the elderly

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa235 ◽

2020 ◽

Vol 2020 (8) ◽

Author(s):

Preci Hamilton ◽

Peyton Lawrence ◽

Christian Valentin Eisenring

Keyword(s):

Screw Fixation ◽

Holistic Approach ◽

The Elderly ◽

Spinal Fracture ◽

Cannulated Screw ◽

Odontoid Fracture ◽

Zenker’S Diverticulum ◽

Type Ii ◽

Odontoid Fractures ◽

Zenker's Diverticulum

Abstract Odontoid fractures constitute the commonest cervical spinal fracture in the elderly. There are varied management approaches with paucity of robust evidence to guide decision-making. We review the case of a 92-years-old man with traumatic Grauer type II B odontoid fracture treated with anterior cannulated screw fixation. Postoperatively, he was noted to have dysphagia due to a zenker’s diverticulum. Further history revealed repair of a zenker’s diverticulum ~40 years prior. Cervical spine images and video fluoroscopy demonstrated a recurrent zenker’s diverticulum. After re-excision of the recurrent zenker’s diverticulum his dysphagia resolved. This unique case describes dysphagia due to recurrent zenker’s diverticulum presenting after anterior cannulated screw fixation for type II B odontoid fracture. The dysphagia was diagnosed and treated in close collaboration with speech and language therapists and otorhinolaryngologist. This underscores the importance of holistic approach to the elderly patient with odontoid fractures.

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Nursing approach to Zenker’s diverticulum surgery patient

International Surgery Journal ◽

10.18203/2349-2902.isj20170232 ◽

2017 ◽

Vol 4 (2) ◽

pp. 784

Author(s):

Sevim Sen ◽

Cigdem Canbolat Seyman ◽

Marios Konstantinou ◽

Stelios Gaitanakis

Keyword(s):

Weight Loss ◽

Nursing Care ◽

Elderly Population ◽

Oral Intake ◽

The Elderly ◽

Oral Feeding ◽

Uneventful Recovery ◽

Zenker’S Diverticulum ◽

Zenker's Diverticulum ◽

Surgery Patient

Zenker’s diverticulum, which is herniation of pharyngeal mucosa, typically occurs in the elderly population with dysphagia, regurgitation, halitosis, and malnutrition. Here we report one case of Zenker’s diverticulum and nursing care and diagnosis process. The patient complained of weight loss, halitosis and intermittent periods of cough. It was diagnosed that the patient had stage two Zenker’s diverticulum on the upper part of esophagus and back to thyroid gland. The patient successfully underwent surgery and stayed five days in hospital. After the postoperative third day it was allowed the patient’s oral feeding. After an uneventful recovery and adequate oral intake, the patient was discharged on the fifth postoperative day.

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Zenker’s diverticulum in the elderly: is operation justified?

The Annals of Thoracic Surgery ◽

10.1016/s0003-4975(98)00502-5 ◽

1998 ◽

Vol 66 (2) ◽

pp. 347-349 ◽

Cited By ~ 35

Author(s):

Donald G. Crescenzo ◽

Victor F. Trastek ◽

Mark S. Allen ◽

Claude Deschamps ◽

Peter C. Pairolero

Keyword(s):

The Elderly ◽

Zenker’S Diverticulum ◽

Zenker's Diverticulum

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Zapping Zenker’s Diverticulum: Gastroscopic Treatment

Canadian Journal of Gastroenterology ◽

10.1155/1999/895947 ◽

1999 ◽

Vol 13 (5) ◽

pp. 405-407 ◽

Cited By ~ 26

Author(s):

Chris JJ Mulder

Keyword(s):

General Anesthesia ◽

Argon Plasma Coagulation ◽

Argon Plasma ◽

The Elderly ◽

Symptomatic Improvement ◽

Massive Pulmonary Embolism ◽

Zenker’S Diverticulum ◽

Female Ratio ◽

Zenker's Diverticulum ◽

Nose And Throat

Zenker’s diverticulum (ZD) is a common cause of dysphagia in the elderly. Many symptomatic elderly are poor candidates for surgery and/or ear, nose and throat treatment. The author’s first experiences with gastroscopic treatment by cutting the Zenker bridge to allow an overflow have recently been published. Only patients with contraindications for general anesthesia were accepted to the pilot group. However, the author now treats all ZD patients in this manner. One hundred and twenty-five patients (male to female ratio 1.6) were referred for treatment from 1993 to 1997. After introduction of the gastroscope into the esophagus, a nasogastric tube was positioned to treat a ZD bridge with a height of less than 1 cm. The ZD bridge was divided by argon plasma coagulation, if necessary, in combination with monopolar forceps, Savary dilator and/or precut needle. All patients received antibiotics, topical anesthesia to the throat, if necessary, and intravenous midazolam, if possible. Radiography was performed after treatment. Normalization of the diet was allowed when the x-ray showed no signs of leakage. All patients referred for treatment were treated successfully. The median age was 77 years (range 41 to 100 years). Symptomatic improvement was seen in all patients after treatment. Complications included subcutaneous emphysema (n=17), mediastinal emphysema (n=5) and bleeding (n=2). One patient (95 years of age) died in her nursing home 27 days after treatment due to massive pulmonary embolism. The thirty-day mortality rate was otherwise zero. Three patients had been previously treated by surgeons and 12 by ear, nose and throat physicians, without sufficient improvement; all were adequately treated by the author. The mean number of treatment sessions was 1.8. This approach seems safe and effective. Treatment of every patient was possible and was carried out, even in patients in very poor condition, without general anesthesia.

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First successful experience of the Zenker's diverticulum endoscopic therapy in Kazakhstan

Clinical review for general practice ◽

10.47407/kr2020.1.3.00023 ◽

2020 ◽

Vol 1 (3) ◽

pp. 45-48

Author(s):

Kanat Batyrbekov ◽

◽

Alexey Zelenyy ◽

Ainur Galiakbarova ◽

◽

...

Keyword(s):

Endoscopic Therapy ◽

The Elderly ◽

Anterior Wall ◽

Zenker’S Diverticulum ◽

Zenker's Diverticulum ◽

Submucosal Tunnel ◽

Invasive Method ◽

Endoscopic Submucosal Tunnel Dissection ◽

The Common ◽

Common Cavity

Zenker's diverticulum tends to occur in the elderly and is generally a relatively rare disorder; the prevalence of Zenker's diverticulum is 1.5–5% of all esophageal diverticula. Men are affected 2-3 times more frequently than women. To date, Zenker's diverticulum is treated mostly by surgery in Kazakhstan, however, with the development of endoscopy the minimally invasive method, endoscopic diverticuloesophagostomy, is being implemented. The transoral treatment is aimed at creating the common cavity between the esophagus and the diverticulum in order to prevent food accumulation in the diverticulum. The anterior wall between these two structures consists of the diverticular wall, m. сricopharyngeus and esophagus wall, the septum transsection automatically ensures myotomy. Both open surgery and endoscopic transoral treatment of Zenker's diverticulum result in reduced symptoms in 94–100% of patients. The paper reports the first successful experience of the Zenker's diverticulum treatment by endoscopic submucosal tunnel dissection in Kazakhstan.

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