The principles of treatment include division of the obstructing cricopharyngeal muscle and adequate drainage of the pouch. This can be achieved successfully with an endoscopic per-oral technique using an endoscopic stapler, as described by Collard in 1993.
Adequate cervical extension and opening of the mouth are a prerequisite for the procedure, which is otherwise indicated for all patients having a symptomatic ZD larger than 2.0cm. Very small diverticula (< 1.0cm), make it difficult to achieve adequate exposure and a complete myotomy; in contrast, very large diverticula leave behind a residual pouch which may be responsible for postoperative dysphagia.
ESD provides short inpatient and operating times, along with a short anesthesia time (mean of 10 to 30 minutes duration). Also, it only causes a mild postoperative discomfort and the patient is able to resume a diet on the same day. It is therefore cost-effective. The most common encountered complications are chipped teeth, postoperative fever and aspiration pneumonia.
Overall, results of this technique in appropriately selected patients are excellent, with a success rate well above 90%.
Needed equipment for this procedure includes:
- Weerda’s diverticuloscope
- Endopath™ articulating endoscopic stapler ATB 45
- Standard cartridges 45mm/3.5mm
- Endo Stitch™ with 2/0 silk sutures
- Closed-end esophageal suction
- 4mm, 0-degree rigid endoscope, 30cm long
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Cummings CW, Haughey BH, Thomas JR, Harker LA, Flint PW. Cummings Otolaryngology: Head and Neck Surgery. Chapter 74.
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