Zenker\'s diverticulum (ZD), also known as a cricopharyngeal pouch, is a pulsion pseudodiverticulum located dorsally at the pharyngoesophageal junction. The pathophysiology of ZD involves cricopharyngeal spasm, incoordination, impaired upper esophageal sphincter opening, and structural changes in the cricopharyngeal muscle, leading to symptoms such as dysphagia, regurgitation of undigested food, foreign body sensation, halitosis, unintentional weight loss, and respiratory issues. Treatment for symptomatic ZD typically involves myotomy of the cricopharyngeal muscle. Endoscopic techniques, particularly flexible endoscopy septotomy (FES) and Zenker peroral endoscopic myotomy (Z-POEM), have become preferred options due to their minimally invasive nature. This review discusses the techniques and clinical outcomes of FES and Z-POEM, focusing on specific clinical scenarios to guide the choice between these methods. Additionally, the variability in FES techniques, the effectiveness of Z-POEM, and the impact of different diverticulum sizes on treatment outcomes are analyzed, providing a comprehensive overview of current therapeutic approaches for ZD.

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UNASSIGNED: The purpose of this study is to report a case of iatrogenic pharyngoesophageal diverticulum post-anterior cervical discectomy and fusion (ACDF) surgery, its management and management of postoperative complications. We also did a thorough review of literature about iatrogenic pharyngoesophageal diverticulum which is a rarely encountered complication occurring after a commonly performed surgery; ACDF.
UNASSIGNED: Here we describe a case of iatrogenic pharyngoesophageal diverticulum post-ACDF surgery. In this paper we also make comparisons to the 23 cases reported in the literature in terms of: presentations, clinical findings, management courses, and complications. This study was approved by the Institution Review Board of Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. (Ref. no.: IRB-2023-01-473). The reported subject provided written informed consent before initiation of this study.
UNASSIGNED: Our case is a 45-year-old male with a history of ACDF surgery 8 years ago. He presented with dysphagia and regurgitations which started 1 year after ACDF. He was labeled as a case of Zenker\'s diverticulum and underwent multiple failed open and endoscopic surgeries prior to presenting to us. Upon presenting to our center, barium swallow showed the pharyngoesophageal diverticulum. Patient definitive diagnosis of iatrogenic rather than Zenker\'s diverticulum was established intra-operatively with esophagoscopy which revealed exposed hardware inside the diverticulum. He underwent open diverticulectomy and diverticulopexy. Postoperatively he developed pharyngocutanous fistula and right vocal fold palsy, both successfully managed conservatively.
UNASSIGNED: Iatrogenic Pharyngoesophageal diverticulum is a rare complication following ACDF, however prolonged dysphagia shall warrant further investigation by contrast studies. Open diverticulectomy with muscle reinforcement is a good management modality. Due to the complicated anatomy secondary to previous operations, we recommend conservative management for patients with postoperative pharyngocutaneous fistula.

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OBJECTIVE: There is sparse literature discussing the impact of smoking on postoperative outcomes following surgical treatment of Zenker\'s diverticulum. In this study, we seek to characterize differences in the management and outcomes of open Zenker\'s diverticulectomy based on patient smoking status.
METHODS: This paper is a retrospective cohort review. The 2005-2018 American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) database was queried for patients undergoing open Zenker\'s diverticulectomy. Chi-square and multivariable logistic regression were performed to determine statistical associations between postoperative outcomes and smoking status.
RESULTS: Of the 715 identified patients, 70 (9.8 %) were smokers and 645 (91.2 %) were non-smokers. Smokers were younger than non-smokers (mean 63.9 vs. 71.7 years, p < 0.001) and more likely to have a prolonged operative time (20.0 % vs. 11.6 %, p = 0.044). On multivariable regression analysis controlling for demographics and comorbidities, smokers had greater odds than non-smokers for developing overall postoperative complications (OR: 2.776, p = 0.013), surgical infections (OR: 3.194, p = 0.039), medical complications (OR: 3.563, p = 0.011), and medical infections (OR: 1.247, p = 0.016). Smokers also had greater odds for requiring ventilation/intubation (OR: 8.508, p = 0.025) and having a prolonged postoperative stay (OR: 2.425, p = 0.030).
CONCLUSIONS: In a cohort of patients undergoing transcervical Zenker\'s diverticulectomy, smokers are at increased risk for overall complications, medical complications, medical infections, surgical infections, prolonged postoperative stay, and ventilation/intubation.

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OBJECTIVE: To compare clinical outcomes in patients with and without history of tobacco use who underwent Zenker\'s diverticulotomy (ZD).
METHODS: Single institution retrospective review.
METHODS: Tertiary care academic hospital.
METHODS: A retrospective review of patients who underwent ZD via an open stapler, rigid endoscopic CO2 laser, stapler or harmonic scalpel, and flexible endoscopic technique from January 2006 to December 2020 was performed. Data were abstracted for patient demographics, diverticular features, and rates of adverse events and symptomatic recurrence.
RESULTS: Out of 424 patients, 146 (34.4 %) had a history of tobacco use: 126 (29.7 %) were former smokers, and 20 (4.7 %) were active smokers. In univariable cross-sectional analyses, the likelihood of postoperative bleeding, perforation, emergency department visits, unplanned readmission, or recurrence did not demonstrate an association with tobacco use history even after adjustment for age, sex, and surgical approach. Similarly, in Cox Proportional Hazards regression, tobacco use was not associated with an increased risk of recurrence, even after correcting for age, sex, and type of surgery. The median time to recurrence observed in our cohort was 11.5 years amongst non-smokers, 8.7 years amongst former smokers, and 1.2 years amongst active smokers (p = 0.94).
CONCLUSIONS: There were no significant differences in post-operative adverse events or frequency of recurrence of ZD between active, former, and non-smokers. Although underpowered and not statistically significant, median time to recurrence appears to be shorter in smokers when compared with former and non-smokers following surgery.

Zenker diverticulum is a rare disease accounting for 1.5-5% of esophageal diverticula. For a long time, surgical treatment of Zenker pharyngoesophageal diverticula implied open diverticulectomy via cervical approach. However, this intervention is characterized by high postoperative morbidity and recurrence rate. Oral endoscopic minimally invasive cricopharyngoesophagomyotomy has become widespread over the past 10 years. We present a 55-year-old female who underwent endoscopic treatment for recurrent Zenker diverticulum and postoperative esophageal stricture. We obtained favorable result in a patient with recurrent Zenker diverticulum after previous open surgeries complicated by esophageal stricture. Endoscopic management eliminated recurrent diverticulum and esophageal stricture, as well as improved the quality of life. Endoscopic approach is preferable for pharynoesophageal diverticula compared to traditional surgical diverticulectomy. Obvious advantages of this technique are stable functional result, low incidence of complications and mortality, short-term postoperative period with fast rehabilitation. Extended myotomy is essential for successful oral endoscopic cricopharyngoesophagomyotomy.
Ценкеровский дивертикул является редким заболеванием, на долю которого приходится от 1,5 до 5% пищеводных дивертикулов. Длительный период времени хирургическое лечение пациентов с глоточно-пищеводными дивертикулами Ценкера подразумевало открытую дивертикулэктомию из шейного доступа. Однако данное вмешательство характеризуется относительно высоким уровнем послеоперационных осложнений и высокой частотой рецидива. На протяжении последних 10 лет в клинической практике ведущих хирургических клиник все чаще в качестве операции выбора рассматривается минимально инвазивная методика — пероральная эндоскопическая крикофарингоэзофагомиотомия. Пациентка, 55 лет, проходила эндоскопическое лечение в ФГБУ «Национальный медицинский исследовательский центр хирургии им. А.В. Вишневского» Минздрава России по поводу рецидивного дивертикула Ценкера и послеоперационной стриктуры пищевода.
UNASSIGNED: Мы получили убедительный результат при лечении пациентки с рецидивным дивертикулом Ценкера, после ряда открытых операций, осложнившихся стриктурой пищевода. Выполненная эндоскопическая крикофарингоэзофагомиотомия позволила не только избавиться от сложного рецидивного дивертикула и стриктуры пищевода, но и кардинально улучшить качество жизни.
UNASSIGNED: Эндоскопический подход к лечению пациентов с глоточно-пищеводными дивертикулами является оптимальной, современной методикой и предпочтительной альтернативой традиционным хирургическим дивертикулэктомиям. Бесспорными преимуществами данной методики являются устойчивый функциональный результат, низкий уровень осложнений и летальности, а также короткий послеоперационный период с быстрым возвращением пациентов к привычному образу жизни без необходимости проведения длительной реабилитации. Залогом успеха пероральной эндоскопической крикофарингоэзофагомиотомии в достижении высокой эффективности и низкого рецидива является протяженная миотомия.

The efficacy and safety of Zenker\'s peroral endoscopic myotomy (Z-POEM), a current method in the treatment of Zenker\'s diverticulum (ZD), have been demonstrated in a limited number of studies and case reports. This study aimed to report our experience with the Z-POEM method.
Patients with ZD who were treated with Z-POEM between January 2019 and March 2023 and had a followup period of at least 3 months were included in the study. Our primary endpoint was clinical success. A Kothari-Haber score (KHS) of 2 or less at 1 month postoperatively was defined as clinical success. Our secondary endpoints were adverse events and recurrence rates.
In total, 20 patients (males, 65%; mean age, 63 ± 14.4 years) were treated with Z-POEM. The mean ZD septum length was 33.7 (±11.04) mm. The technical success rate was 100% (20/20), and the clinical success rate was 95% (19/20). In 1 case with a large ZD (septum length of 60 mm), the mucosal septum, which was thought to cause partial persistence of symptoms, was treated by endoscopic septotomy. The mean KHS decreased significantly after Z-POEM (preoperative KHS: 7.3 and postoperative KHS: 0.15, P < .0001). The median follow-up period was 10 months (interquartile range, 3-39). No recurrence was observed in any case. Intraprocedural mild subcutaneous emphysema was observed in 4 (20%) cases. Emphysema regressed spontaneously in the postoperative period without any treatment.
Zenker\'s peroral endoscopic myotomy is a successful and reliable method in the treatment of ZD, with low recurrence rates.