Feasibility and outcome of endoscopic staple-assisted esophagodiverticulostomy for Zenker's diverticulum

Objectives/Hypothesis. Endoscopic staple-assisted esophagodiverticulostomy (ESED) is a newly described method of surgically correcting Zenker's divert iculum. Initial reports on the ease and success of the surgery have been qu ite enthusiastic, making it seem the procedure of choice. We initiated the procedure in an algorithm of treatment of Zenkees diverticulum, to further explore the feasibility and outcome of this new technique. Study Design: Th is is a case series of 23 patients with Zenker's diverticulum who have unde rgone surgical repair. For each patient, an attempt at ESED was made. If un successful, an open approach was then taken. Results. Seven of 23 patients (30%) were unable to be treated with ESED because of inability to expose th e diverticulum or unfavorable anatomy of the diverticulum, itself. Of the r emaining 16 patients, ESED was successful in resolving the symptoms of dive rticulum. in 14 (87%). Two patients (13%) were somewhat improved but had pe rsistent dysphagia. No significant complications occurred. All patients res umed oral diet within the first 24 hours after surgery. Conclusion: Esophag odiverticulostomy is an excellent method of surgically correcting Zenkers d iverticulum in many patients, but anatomical considerations may prevent its use, making open approaches of continued importance in a surgeon's armamen tarium.