The management of
Zenker's diverticulum remains controversial, as both external and endoscopic procedures are potentially associated with post-operative complications and risks. The endoscopic approach is based on cricopharyngeal
myotomy or myectomy by
laser,
cautery or stapling. A retrospective chart review has been made from December 1994 to April 2009 of all patients with
Zenker's diverticulum treated by endoscopic cricopharyngeal myectomy using CO(2)
laser at the Department of Otorhinolaryngology - Head and Neck Surgery of the University of Brescia, Italy. Of the 28 patients (19 males, 9 females; mean age, 64 years; range, 46-95) scheduled for the trans-oral procedure, 27 (96%) were endoscopically treated. Diagnosis was based on the patient's history, flexible fiberoptic examination of the larynx, hypopharynx, and oesophagus, and videofluoroscopy with
barium. Exclusion criteria included severe medical co-morbidities, impossibility to endoscopically expose the
diverticulum, and small (< 2 cm) or large (> 6 cm)
diverticula. The endoscopic procedure was performed using a CO(2)
laser to section the cricopharyngeal muscle and remove the posterior part in order to obtain partial myectomy. Major complications occurred in 2 (7%) patients. No cases of recurrent nerve
paralysis, pharyngo-
cutaneous fistula, neck
emphysema, post-operative
bleeding,
mediastinitis or
aspiration pneumonia were observed in the present series. A swallow survey was obtained by telephone: 85% of patients reported improved swallowing (without symptoms in 11 and with moderate
dysphagia in 7). Based on the present series, endoscopic CO(2)
laser cricopharyngeal myectomy for
Zenker's diverticulum can be considered an effective and safe procedure, with reduced hospitalization time and complication rate.