Trans Oral Endoscopic Stapled Esophago Diverticulostomy (toesed ) for Zenker’s Diverticulum

Introduction: Zenker’s diverticulum is a known cause for dysphagia and is treated usually by resection or diverticulopexy through a neck incision. In recent years an endoscopic per-oral method has been described. A cohort of patients was treated and long-term follow up was obtained.
Materials and Methods: All patients presented with the diagnosis of Zenker’s diverticulum were considered as candidates for TOESED without selection. We retrospectively reviewed 55 charts of patients that underwent TOESED at our institutions between 2002 and 2007. TOESED was performed using multiple firings of a linear stapler trans orally in an endoscopic approach.
Results: 55 patients suffering from Zenker’s diverticulum underwent TOESED. The mean age was 74 (48-86), and male to female ratio 3:1. Mean operative time was 25 minutes (15-45 minutes), and estimated blood loss was negligible. The mean length of hospital stay was 48 hours. Patients were fed clear liquid diet the day after surgery. Three complications (5.45%) occurred: 1 esophageal perforation that was treated consrvatively, 1 severe esophageal edema causing dysphagia that was treated with temporary gastrostomy, and 1 mucosal tear of the pharynx treated by suturing and NG tube for drainage. 2 cases were aborted for technical difficulty, and treated later with open technique. All patients except for one were satisfied with the procedure. On long-term follow up there were 2 recurrences (3.6%).
Conclusion: TOESED is a feasible and safe approach to treat patients suffering from a Zenker’s diverticulum. The length of hospital stay is short and complication rate is low.

Session: Podium Presentation

Program Number: S068

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