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A FLEXIBLE ENDOSCOPIC SUBMUCOSAL TUNNELING TECHNIQUE FOR ZENKER's DIVERTICULUM IS FEASIBLE, SAFE AND RESULTS IN EXCELLENT OUTCOMES
Stephanie M. Novak*, Kristine Kuchta, Herbert M. Hedberg, Tyler Hall, Michael Ujiki
General Surgery, NorthShore University Health System, Evanston, IL
INTRODUCTION
Given the limitations of a rigid endoscopic approach to Zenker's diverticulum, use of a flexible endoscopic approach would be welcomed if feasible, safe and effective. Our study sought to review outcomes and assess feasibility and safety for patients with a Zenker's diverticulum repaired by flexible endoscopy and a submucosal tunneling technique from a single institution.
METHODS
A retrospective review of a prospectively collected Quality database was performed for patients who had repair of a Zenker's diverticulum via flexible endoscopy. Pre-, intra- and postoperative data was collected. The technique involves use of standard endoscopic equipment, creation of a mucosotomy, submucosal tunneling distal to the cricopharyngeus muscle, a complete cricopharyngeal myotomy and secure mucosotomy closure. McNemar's test was used to assess the resolution of symptoms pre- to post-operatively.
RESULTS
Eighteen patients underwent repair and all were technically successful. Eight (44%) were male, and average age was 73.0 years (±10.8). Average OR time was 37.7 minutes (±15.5). Patients on average reported symptom duration of 11.5 months preoperatively. Of the 18 patients, 16 were discharged on the day of the procedure. The average diverticulum size was 3.4 cm. No complications were reported during surgery. Two patients had postop leak and recovered without intervention or sequelae. One required reoperation through a repeat endoscopic approach due to incomplete myotomy at the first operation and experienced near complete symptom resolution. Average follow up was 384 days. Complete symptom resolution occurred in 72.2% of patients. On average, patients experienced 87.4% improvement in dysphagia, 98.8% improvement in regurgitation, 98% improvement in halitosis, 99.4% improvement in cough and 100% resolution in aspiration. There was complete resolution of dysphagia in 72.2% (p=0.0003), regurgitation in 93.3% (p=0.0002), cough in 88.9% (p=0.0339), aspiration in 100% (p=0.0833), halitosis in 80% (p=0.0455) and gurgling in 87.5% (p=0.0082) of patients. In preoperative and short-term quality of life surveys, patients reported significant improvement in RSI and GERD symptoms (p=0.0230, p=0.0041).
DISCUSSION
A flexible endoscopic submucosal tunneling technique is feasible, safe and effective for repair of Zenker's diverticula. Most patients are able to discharge on the day of surgery and most experience complete resolution of their symptoms.
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