Endoscopy 2007; 39(2): 141-145
DOI: 10.1055/s-2007-966164
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Argon plasma coagulation for flexible endoscopic Zenker’s diverticulotomy

T.  Rabenstein1 , A.  May1 , J.  Michel1 , H.  Manner1 , O.  Pech1 , L.  Gossner1 , C.  Ell1
  • 1Department of Medicine II, Dr.-Horst-Schmidt-Kliniken Wiesbaden, Wiesbaden, Germany
Further Information

Publication History

eingereicht 26 September 2006

akzeptiert 20 December 2006

Publication Date:
27 February 2007 (online)

Background and study aims: The increasing use of flexible endoscopy to treat symptomatic Zenker’s diverticulum is only partially supported by data on safety and benefits. This retrospective study reports the mid-term results of argon plasma coagulation (APC) for flexible endoscopic therapy of Zenker’s diverticulum.

Patients and methods: Between January 2002 and July 2006, 41 patients (27 men, 14 women, mean age ± standard deviation [SD] 73 ± 11 years) were treated by means of APC flexible endoscopic Zenker’s diverticulotomy. Technical and immediate clinical success (on a 3-month control examination) was assessed for the entire group. Mid-term follow-up data were obtained for patients treated until December 2005 (n = 34) with a mean ± SD follow-up period of 16 ± 5 months.

Results: Technical success was achieved in all 41 patients, with a mean ± SD of 3 ± 2 treatment sessions during one or two hospitalizations (1 - 3 sessions for 78 % patients, > 3 sessions for 22 % patients). Immediate clinical success was achieved in 95 % of cases. Fever occurred in seven patients (17 %), lasting less than 24 hours in three patients (7 %) and associated with clinical infections in four (10 %); one perforation occurred, which was managed conservatively. In the patients for whom we had mid-term follow-up data, 5/34 experienced recurrence and achieved a successful clinical outcome after retreatment with APC.

Conclusions: APC treatment of Zenker’s diverticulum is safe and effective in the short term, with a mean of three treatment sessions. Recurrence rates of around 15 % have to be expected on mid-term follow-up. The relative value of APC vs. needle-knife techniques can only be clarified in a prospective randomized study.

References

  • 1 Richtsmeier W J. Endoscopic management of Zenker diverticulum: the staple-assisted approach.  Am J Med. 2003;  115 (Suppl 3A) 175S-178S
  • 2 Chang C Y, Payyapilli R J, Scher R L. Endoscopic staple diverticulostomy for Zenker’s diverticulum: review of literature and experience in 159 consecutive cases.  Laryngoscope. 2003;  113 957-965
  • 3 Groth S, Seewald S, de Weerth A. et al . Therapy of Zenker’s diverticulum [article in German, English abstract].  Endoskopie Heute. 2005;  18 144-151
  • 4 Mulder C J, den Hartog G, Robijn R J, Thies J E. Flexible endoscopic treatment of Zenker’s diverticulum: a new approach.  Endoscopy. 1995;  27 438-442
  • 5 Ishioka S, Sakai P, Maluf Filho F, Melo J M. Endoscopic incision of Zenker’s diverticula.  Endoscopy. 1995;  27 433-437
  • 6 Hashiba K, de Paula A L, da Silva J G. et al . Endoscopic treatment of Zenker’s diverticulum.  Gastrointest Endosc. 1999;  49 93-97
  • 7 Vogelsang A, Preiss C, Neuhaus H, Schumacher B. Endotherapy of Zenker’s diverticulum using the needle-knife technique: long-term follow-up.  Endoscopy. 2006 October 16;  [Epub ahead of print]
  • 8 Wahab P J, Mulder C J, den Hartog G, Thies J E. Argon plasma coagulation in flexible gastrointestinal endoscopy: pilot experiences.  Endoscopy. 1997;  29 176-181
  • 9 Pech O, May A, Gossner L. et al . Endoscopic therapy for Zenker’s diverticulum by means of argon plasma coagulation.  Z Gastroenterol. 2002;  40 517-520
  • 10 Mulder C J. Zapping Zenker’s diverticulum: gastroscopic treatment.  Can J Gastroenterol. 1999;  13 405-407
  • 11 Inoue H. Treatment of esophageal and gastric tumors.  Endoscopy. 2001;  33 119-125
  • 12 Manner H, May A, Faerber M. et al . Safety and efficacy of a new high power argon plasma coagulation system (hp-APC) in lesions of the upper gastrointestinal tract.  Dig Liver Dis. 2006;  38 471-478
  • 13 Sakai P, Ishioka S, Maluf-Filho F. et al . Endoscopic treatment of Zenker’s diverticulum with an oblique-end hood attached to the endoscope.  Gastrointest Endosc. 2001;  54 760-763
  • 14 Evrard S, Le Moine O, Hassid S, Deviere J. Zenker’s diverticulum: a new endoscopic treatment with a soft diverticuloscope.  Gastrointest Endosc. 2003;  58 116-120
  • 15 Witterick I J, Gullane P J, Yeung E. Outcome analysis of Zenker’s diverticulectomy and cricopharyngeal myotomy.  Head Neck. 1995;  17 382-388

T. Rabenstein, MD

Department of Medicine II

Dr.-Horst-Schmidt-Kliniken Wiesbaden

Academic Teaching Hospital of the Johannes-Gutenberg-University Mainz

Ludwig-Erhard-Str. 100

65199 Wiesbaden

Germany

Fax: +49-611-432418

Email: thomas.rabenstein@hsk-wiesbaden.de