The retrospective design is a significant bias concerning the data collected, which can have an impact on results. Randomized studies are difficult to implement, given the small number of patients, acquisition of one specific technique per referral center, and the fact that the patients are often specifically referred for a selected technique of treatment. However, we think that the consistency of treatment Selleck INCB024360 over the whole study and the detailed

long-term clinical outcome allow us to provide data useful to clinical practice. In conclusion, flexible endoscopy has become a new standard for ZD treatment when performed with adequate equipment inspired by rigid diverticuloscopes. This approach has a lower rate of adverse events than open surgery or endoscopic stapling techniques. Moreover, the risk of general anesthesia in elderly patients can be avoided because airways are protected by the diverticuloscope. Recurrence

is about 25% in the long term but is easily amenable to successful repeated endoscopic treatment. “
“Zenker’s diverticulum (ZD) is an acquired disease that is formed by outpouching of hypopharyngeal mucosa between the inferior pharyngeal constrictor and the cricopharyngeus muscle in an area of junctional muscle weakness known as Killian’s triangle.1 Although the need for myotomy in addition to surgical correction of the diverticulum has been well described, it is only in the past 20 years that more clear insight has emerged on the pathophysiology of ZD despite its original description in the 1700s.1 Specifically, Cook et al2 elegantly demonstrated Omipalisib that in patients with ZD, the upper esophageal sphincter is fibrotic, contributing to reduced compliance, incomplete opening, and therefore increased pressure proximal to the cricopharyngeal Amine dehydrogenase outlet. This leads to a “blow out” of the weakest part of the pharyngeal wall and formation of the diverticulum. Other studies have been conflicting in demonstrating

an increased tone within the sphincter.1 Nevertheless, these and other data have reinforced that cricopharyngeal myotomy is essential in relieving symptoms and preventing recurrent diverticula.1 The traditional approach to cricopharyngeal myotomy and to diverticulectomy or -pexy has been open through a lateral neck incision. In the past 2 decades, however, this operation has been shifting to a transoral endoscopic approach using a rigid endoscope because of equal efficacy, shorter hospital stay, faster return to oral intake, and lower morbidity because of a reduction in adverse events compared with open surgery.3 Such adverse events may include injury to the recurrent laryngeal nerve, mediastinitis, and fistula.1 Not all patients with ZD are amenable to transoral endoscopic therapy using a rigid endoscope.