Cricopharyngomyotomy: Outcomes of flexible endoscopic management of small and medium sized Zenker's diverticulum

Background: Zenker's diverticulum (ZD) was historically treated with an open transcervical myotomy with diverticulectomy, but endoscopic approaches have gained popularity, though with little recent data. This study aimed to report flexible endoscopic cricopharyngomyotomy (FEC) outcomes, particularly in smaller diverticula.

Methods: Patients with ZD treated with FEC at a tertiary center were reviewed. Patients were grouped by diverticulum size: small (sZD)≤1.5 ​cm; medium (mZD) ​> ​1.5 ​cm.

Results: Of 30 patients, median age, BMI, sex, and comorbidities were similar between sZD (n ​= ​18) and mZD (n ​= ​12). Overall, 80.0 ​% had the procedure performed with a needle knife. Median number of clips for mucosotomy closure (5.0[5.0,6.0]vs.7.0[5.0,7.0]clips;p ​= ​0.051), operative time (59.5[51.0,75.0]vs.74.5[51.0,93.5]minutes;p ​= ​0.498), length-of-stay (1.0[1.0,1.0]vs.1.0[1.0,1.0]days;p ​= ​0.397), and follow-up (20.8[1.1,33.4]vs.15.6[5.4,50.4]months;p ​= ​0.641) were comparable. There were no postoperative leaks; incomplete myotomy occurred in one sZD, yielding a clinical success rate of 96.7 ​%.

Conclusions: FEC has a high success rate for ZD and an advantage in small diverticula, difficult to treat with stapling or open technique.