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

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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Endoscopic treatment of Zenker’s diverticulum with Ligasure: simple, safe and effective

Endoscopy International Open ◽

10.1055/a-0809-4875 ◽

2019 ◽

Vol 07 (02) ◽

pp. E203-E208 ◽

Cited By ~ 2

Author(s):

Pilar Diez Redondo ◽

Henar Núñez Rodríguez ◽

Marina de Benito Sanz ◽

Raúl Torres Yuste ◽

Manuel Pérez-Miranda

Keyword(s):

Clinical Success ◽

The Elderly ◽

Flexible Endoscopy ◽

Zenker’S Diverticulum ◽

Delayed Bleeding ◽

Zenker's Diverticulum ◽

Second Procedure ◽

Tissue Sealing

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 – effectiveness of endoscopic therapy

Perspectives in Surgery ◽

10.33699/pis.2020.99.6.244-248 ◽

2020 ◽

Vol 99 (6) ◽

pp. 244-248

Keyword(s):

Endoscopic Therapy ◽

Flexible Endoscopy ◽

Common Type ◽

Zenker’S Diverticulum ◽

Esophageal Diverticulum ◽

Zenker's Diverticulum ◽

Technical Advances ◽

Endoscopic Methods ◽

Methods Of Treatment ◽

Lower Morbidity

Zenker’s diverticulum is the most common type of esophageal diverticulum with a prevalence of 0.01 to 0.11 %, usually found in middle-aged and older patients. The prevalent symptoms are dysphagia and regurgitation. Treatment is recommended in symptomatic patients and consists of myotomy of the cricopharyngeal muscle. Both surgical and endoscopic methods are used in the treatment of Zenker’s diverticulum. With technical advances, flexible endoscopy has come to the forefront in the treatment of Zenker’s diverticulum, especially in older polymorbid patients. Its advantages include lower morbidity and mortality, shorter surgery time, the possibility of performing the procedure without general anesthesia, and a shorter hospital stay, including early oral food intake. In this paper we present our own experience with endoscopic treatment of Zenker’s diverticulum and at the same time we provide a review of effectiveness with other methods of treatment.

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