Flexible endoscopy septotomy for Zenker's diverticulum (ZD) is an alternative to endostapling. However, long-term data are sparse and studies are heterogeneous. The aim was to assess the clinical success of flexible endoscopy diverticuloscope-assisted septotomy according to all ZD-related symptoms and identify potential prognostic variables.
Prospective database of all patients with ZD undergoing septotomy followed up for ≥24 months were analyzed. Septotomy was conducted by the diverticuloscope-assisted technique. Dysphagia, regurgitation and respiratory symptoms (day and night time) were scored by their weekly frequency from 0 to 3 on a solid food diet. Clinical success (asymptomatic state) was defined as a maximum of two symptoms with score 1 (once per week). Prognostic variables of clinical success included age, sex, pre-treatment total symptom score, pre- and post-treatment ZD size, and septotomy length. Kaplan-Meier method and Cox proportional-hazards model were used to calculate the crude and adjusted Hazard Ratio (HR).
Septotomy was attempted and achieved in 89 patients in a single session. Clinical success at the ITT analysis was 69%, 64%, and 46% at 6, 24, and 48 months, respectively. Adverse events occurred in 3 cases: perforation in 2 (2%) and post-procedural bleeding in 1 (1%). Independent variables for failure at 6 months were septotomy length ≤25 mm (HR 6.34) and pre-treatment ZD size ≥50 mm (HR 11.08); whereas at 48 months were septotomy length ≤25 (HR 2.20) and post-treatment ZD size ≥10 mm (HR 2.03). Success rates for ZD ranging from 30 mm to 49 mm with a septotomy >25 mm were 100% and 71% at 6 and 48 months, respectively.
Flexible endoscopic septotomy for ZD is feasible and safe. Success in treatment correlates with length of septotomy and size of ZD that should ultimately tailor the appropriate approach.