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.