Esophageal diverticulum: New perspectives in the era of minimally invasive endoscopic treatment
|
摘要
Esophageal diverticula are rare conditions that cause esophageal symptoms, such as dysphagia, regurgitation, and chest pain. They are classified according to their location and characteristic pathophysiology into three types: epiphrenic diverticulum, Zenker's diverticulum, and Rokitansky diverticulum. The former two disorders take the form of protrusions, and symptomatic cases require interventional treatment. However, the esophageal anatomy presents distinct challenges to surgical resection of the diverticulum, particularly when it is located closer to the oral orifice. Since the condition itself is not malignant,minimally invasive endoscopic approaches have been developed with a focus on alleviation of symptoms. Several types of endoscopic devices and techniques are currently employed, including peroral endoscopic myotomy(POEM). However,the use of minimally invasive endoscopic approaches, like POEM, has allowed the development of new disorder called iatrogenic esophageal diverticula. In this paper, we review the pathophysiology of each type of diverticulum and the current state-of-the-art treatment based on our experience.
Esophageal diverticula are rare conditions that cause esophageal symptoms, such as dysphagia, regurgitation, and chest pain. They are classified according to their location and characteristic pathophysiology into three types: epiphrenic diverticulum, Zenker's diverticulum, and Rokitansky diverticulum. The former two disorders take the form of protrusions, and symptomatic cases require interventional treatment. However, the esophageal anatomy presents distinct challenges to surgical resection of the diverticulum, particularly when it is located closer to the oral orifice. Since the condition itself is not malignant,minimally invasive endoscopic approaches have been developed with a focus on alleviation of symptoms. Several types of endoscopic devices and techniques are currently employed, including peroral endoscopic myotomy(POEM). However,the use of minimally invasive endoscopic approaches, like POEM, has allowed the development of new disorder called iatrogenic esophageal diverticula. In this paper, we review the pathophysiology of each type of diverticulum and the current state-of-the-art treatment based on our experience.
Esophageal diverticula are rare conditions that cause esophageal symptoms, such as dysphagia, regurgitation, and chest pain. They are classified according to their location and characteristic pathophysiology into three types: epiphrenic diverticulum, Zenker's diverticulum, and Rokitansky diverticulum. The former two disorders take the form of protrusions, and symptomatic cases require interventional treatment. However, the esophageal anatomy presents distinct challenges to surgical resection of the diverticulum, particularly when it is located closer to the oral orifice. Since the condition itself is not malignant,minimally invasive endoscopic approaches have been developed with a focus on alleviation of symptoms. Several types of endoscopic devices and techniques are currently employed, including peroral endoscopic myotomy(POEM). However,the use of minimally invasive endoscopic approaches, like POEM, has allowed the development of new disorder called iatrogenic esophageal diverticula. In this paper, we review the pathophysiology of each type of diverticulum and the current state-of-the-art treatment based on our experience.
引文
1 Soares R,Herbella FA,Prachand VN,Ferguson MK,Patti MG.Epiphrenic diverticulum of the esophagus.From pathophysiology to treatment.J Gastrointest Surg 2010;14:2009-2015[PMID:20437107 DOI:10.1007/s11605-010-1216-9]
2 Tedesco P,Fisichella PM,Way LW,Patti MG.Cause and treatment of epiphrenic diverticula.Am J Surg2005;190:891-894[PMID:16307941 DOI:10.1016/j.amjsurg.2005.08.016]
3 Nehra D,Lord RV,DeMeester TR,Theisen J,Peters JH,Crookes PF,Bremner CG.Physiologic basis for the treatment of epiphrenic diverticulum.Ann Surg 2002;235:346-354[PMID:11882756]
4 Melman L,Quinlan J,Robertson B,Brunt LM,Halpin VJ,Eagon JC,Frisella MM,Matthews BD.Esophageal manometric characteristics and outcomes for laparoscopic esophageal diverticulectomy,myotomy,and partial fundoplication for epiphrenic diverticula.Surg Endosc 2009;23:1337-1341[PMID:18813978 DOI:10.1007/s00464-008-0165-9]
5 Del Genio A,Rossetti G,Maffetton V,Renzi A,Brusciano L,Limongelli P,Cuttitta D,Russo G,Del Genio G.Laparoscopic approach in the treatment of epiphrenic diverticula:long-term results.Surg Endosc2004;18:741-745[PMID:15216856]
6 Fernando HC,Luketich JD,Samphire J,Alvelo-Rivera M,Christie NA,Buenaventura PO,Landreneau RJ.Minimally invasive operation for esophageal diverticula.Ann Thorac Surg 2005;80:2076-2080[PMID:16305847 DOI:10.1016/j.athoracsur.2005.06.007]
7 Varghese TK,Marshall B,Chang AC,Pickens A,Lau CL,Orringer MB.Surgical treatment of epiphrenic diverticula:a 30-year experience.Ann Thorac Surg 2007;84:1801-1809;discussion 1801-1809[PMID:18036889 DOI:10.1016/j.athoracsur.2007.06.057]
8 D'Journo XB,Ferraro P,Martin J,Chen LQ,Duranceau A.Lower oesophageal sphincter dysfunction is part of the functional abnormality in epiphrenic diverticulum.Br J Surg 2009;96:892-900[PMID:19591165 DOI:10.1002/bjs.6652]
9 Bredenoord AJ,Fox M,Kahrilas PJ,Pandolfino JE,Schwizer W,Smout AJ;International High Resolution Manometry Working Group.Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography.Neurogastroenterol Motil 2012;24 Suppl 1:57-65[PMID:22248109 DOI:10.1111/j.1365-2982.2011.01834.x]
10 Sato H,Takahashi K,Mizuno KI,Hashimoto S,Yokoyama J,Hasegawa G,Terai S.Esophageal motility disorders:new perspectives from high-resolution manometry and histopathology.J Gastroenterol 2018;53:484-493[PMID:29134329 DOI:10.1007/s00535-017-1413-3]
11 Fasano NC,Levine MS,Rubesin SE,Redfern RO,Laufer I.Epiphrenic diverticulum:clinical and radiographic findings in 27 patients.Dysphagia 2003;18:9-15[PMID:12497191 DOI:10.1007/s00455-002-0075-2]
12 de Schipper JP,Pull ter Gunne AF,Oostvogel HJ,van Laarhoven CJ.Spontaneous rupture of the oesophagus:Boerhaave's syndrome in 2008.Literature review and treatment algorithm.Dig Surg 2009;26:1-6[PMID:19145081 DOI:10.1159/000191283]
13 Klaus A,Hinder RA,Swain J,Achem SR.Management of epiphrenic diverticula.J Gastrointest Surg2003;7:906-911[PMID:14592666]
14 Rosati R,Fumagalli U,Elmore U,de Pascale S,Massaron S,Peracchia A.Long-term results of minimally invasive surgery for symptomatic epiphrenic diverticulum.Am J Surg 2011;201:132-135[PMID:21167369 DOI:10.1016/j.amjsurg.2010.03.016]
15 Brandeis AE,Singhal S,Lee TH,Mittal SK.Surgical management of epiphrenic diverticulum:A singlecenter experience and brief review of literature.Am J Surg 2018;216:280-285[PMID:28778314 DOI:10.1016/j.amjsurg.2017.06.039]
16 Onwugbufor MT,Obirieze AC,Ortega G,Allen D,Cornwell EE,Fullum TM.Surgical management of esophageal diverticulum:a review of the Nationwide Inpatient Sample database.J Surg Res 2013;184:120-125[PMID:23751803 DOI:10.1016/j.jss.2013.05.036]
17 Inoue H,Minami H,Kobayashi Y,Sato Y,Kaga M,Suzuki M,Satodate H,Odaka N,Itoh H,Kudo S.Peroral endoscopic myotomy(POEM)for esophageal achalasia.Endoscopy 2010;42:265-271[PMID:20354937 DOI:10.1055/s-0029-1244080]
18 Inoue H,Sato H,Ikeda H,Onimaru M,Sato C,Minami H,Yokomichi H,Kobayashi Y,Grimes KL,Kudo SE.Per-Oral Endoscopic Myotomy:A Series of 500 Patients.J Am Coll Surg 2015;221:256-264[PMID:26206634 DOI:10.1016/j.jamcollsurg.2015.03.057]
19 Inoue H,Shiwaku H,Iwakiri K,Onimaru M,Kobayashi Y,Minami H,Sato H,Kitano S,Iwakiri R,Omura N,Murakami K,Fukami N,Fujimoto K,Tajiri H.Clinical practice guidelines for peroral endoscopic myotomy.Dig Endosc 2018;30:563-579[PMID:30022514 DOI:10.1111/den.13239]
20 Sato H,Sato Y,Takeuchi M,Takahashi K,Takeda SR,Inoue H,Kobayashi M.Salvage peroral endoscopic myotomy for esophageal diverticulum.Endoscopy 2015;47 Suppl 1 UCTN:E14-E15[PMID:25603506 DOI:10.1055/s-0034-1390735]
21 Sato H,Sato Y,Hashimoto S,Mizuno K,Nakajima N,Terai S.Gastrointestinal:Salvage peroral endoscopic myotomy for outflow obstruction with growing esophageal diverticulum.J Gastroenterol Hepatol 2016;31:1237[PMID:27059011 DOI:10.1111/jgh.13397]
22 Otani K,Tanaka S,Kawara F,Fujikawa J,Sawada A,Uemura R,Tanigawa T,Watanabe T,Azuma T,Fujiwara Y.Distal esophageal spasm with multiple esophageal diverticula successfully treated by peroral endoscopic myotomy.Clin J Gastroenterol 2017;10:442-446[PMID:28756484 DOI:10.1007/s12328-017-0768-6]
23 Demeter M,Bánov?in P,?uri?ek M,Kunda R,Hyrdel R.Peroral endoscopic myotomy in achalasia and large epiphrenic diverticulum.Dig Endosc 2018;30:260-262[PMID:28884499 DOI:10.1111/den.12961]
24 Yang J,Zeng X,Yuan X,Chang K,Sanaei O,Fayad L,Kumbhari V,Singh V,Kalloo AN,Hu B,Khashab MA.An international study on the use of peroral endoscopic myotomy(POEM)in the management of esophageal diverticula:the first multicenter D-POEM experience.Endoscopy 2019;51:346-349[PMID:30453378 DOI:10.1055/a-0759-1428]
25 Sato H,Takahashi K,Takeuchi M,Sato Y,Hashimoto S,Mizuno K,Terai S.Epiphrenic diverticulum of the esophagus after peroral endoscopic myotomy.Endoscopy 2015;47 Suppl 1 UCTN:E509-E510[PMID:26492299 DOI:10.1055/s-0034-1393232]
26 Badillo R,Francis D,DeVault K.Formation of large esophageal diverticulum after peroral endoscopic myotomy.Gastrointest Endosc 2015;82:962;discussion 963[PMID:26099930 DOI:10.1016/j.gie.2015.05.020]
27 Akintoye E,Kumar N,Obaitan I,Alayo QA,Thompson CC.Peroral endoscopic myotomy:a metaanalysis.Endoscopy 2016;48:1059-1068[PMID:27617421 DOI:10.1055/s-0042-114426]
28 Talukdar R,Inoue H,Nageshwar Reddy D.Efficacy of peroral endoscopic myotomy(POEM)in the treatment of achalasia:a systematic review and meta-analysis.Surg Endosc 2015;29:3030-3046[PMID:25539695 DOI:10.1007/s00464-014-4040-6]
29 Law R,Katzka DA,Baron TH.Zenker's Diverticulum.Clin Gastroenterol Hepatol 2014;12:1773-1782;quiz e111-112[PMID:24055983 DOI:10.1016/j.cgh.2013.09.016]
30 Beard K,Swanstr?m LL.Zenker's diverticulum:flexible versus rigid repair.J Thorac Dis 2017;9:S154-S162[PMID:28446979 DOI:10.21037/jtd.2017.03.133]
31 Watemberg S,Landau O,Avrahami R.Zenker's diverticulum:reappraisal.Am J Gastroenterol 1996;91:1494-1498[PMID:8759648]
32 Yuan Y,Zhao YF,Hu Y,Chen LQ.Surgical treatment of Zenker's diverticulum.Dig Surg 2013;30:207-218[PMID:23838812 DOI:10.1159/000351433]
33 Ishaq S,Sultan H,Siau K,Kuwai T,Mulder CJ,Neumann H.New and emerging techniques for endoscopic treatment of Zenker's diverticulum:State-of-the-art review.Dig Endosc 2018;30:449-460[PMID:29423955 DOI:10.1111/den.13035]
34 Sato H,Takeuchi M,Terai S.Gastrointestinal:Endoscopic diverticulectomy for the treatment of Zenker's diverticulum with a unique"tip":A first case report in Japan.J Gastroenterol Hepatol 2019[PMID:30714200 DOI:10.1111/jgh.14599]
35 Chang CY,Payyapilli RJ,Scher RL.Endoscopic staple diverticulostomy for Zenker's diverticulum:review of literature and experience in 159 consecutive cases.Laryngoscope 2003;113:957-965[PMID:12782805 DOI:10.1097/00005537-200306000-00009]
36 Smith SR,Genden EM,Urken ML.Endoscopic stapling technique for the treatment of Zenker diverticulum vs standard open-neck technique:a direct comparison and charge analysis.Arch Otolaryngol Head Neck Surg 2002;128:141-144[PMID:11843721]
37 Baldwin DL,Toma AG.Endoscopic stapled diverticulotomy:a real advance in the treatment of hypopharyngeal diverticulum.Clin Otolaryngol Allied Sci 1998;23:244-247[PMID:9669074]
38 Counter PR,Hilton ML,Baldwin DL.Long-term follow-up of endoscopic stapled diverticulotomy.Ann RColl Surg Engl 2002;84:89-92[PMID:11995771]
39 Vogelsang A,Preiss C,Neuhaus H,Schumacher B.Endotherapy of Zenker's diverticulum using the needle-knife technique:long-term follow-up.Endoscopy 2007;39:131-136[PMID:17041841 DOI:10.1055/s-2006-944657]
40 Charles T,Sturgeon MD.Esophageal diverticula.JAMA 1929;92:379-385[DOI:10.1001/jama.1929.02700310025008]
41 SCHICK A,YESNER R.Traction diverticulum of esophagus with exsanguination:report of a case.Ann Intern Med 1953;39:345-349[PMID:13080892]
42 Ferreira LE,Simmons DT,Baron TH.Zenker's diverticula:pathophysiology,clinical presentation,and flexible endoscopic management.Dis Esophagus 2008;21:1-8[PMID:18197932 DOI:10.1111/j.1442-2050.2007.00795.x]
43 Siddiq MA,Sood S,Strachan D.Pharyngeal pouch(Zenker's diverticulum).Postgrad Med J 2001;77:506-511[PMID:11470929]
44 Bizzotto A,Iacopini F,Landi R,Costamagna G.Zenker's diverticulum:exploring treatment options.Acta Otorhinolaryngol Ital 2013;33:219-229[PMID:24043908]
2 Tedesco P,Fisichella PM,Way LW,Patti MG.Cause and treatment of epiphrenic diverticula.Am J Surg2005;190:891-894[PMID:16307941 DOI:10.1016/j.amjsurg.2005.08.016]
3 Nehra D,Lord RV,DeMeester TR,Theisen J,Peters JH,Crookes PF,Bremner CG.Physiologic basis for the treatment of epiphrenic diverticulum.Ann Surg 2002;235:346-354[PMID:11882756]
4 Melman L,Quinlan J,Robertson B,Brunt LM,Halpin VJ,Eagon JC,Frisella MM,Matthews BD.Esophageal manometric characteristics and outcomes for laparoscopic esophageal diverticulectomy,myotomy,and partial fundoplication for epiphrenic diverticula.Surg Endosc 2009;23:1337-1341[PMID:18813978 DOI:10.1007/s00464-008-0165-9]
5 Del Genio A,Rossetti G,Maffetton V,Renzi A,Brusciano L,Limongelli P,Cuttitta D,Russo G,Del Genio G.Laparoscopic approach in the treatment of epiphrenic diverticula:long-term results.Surg Endosc2004;18:741-745[PMID:15216856]
6 Fernando HC,Luketich JD,Samphire J,Alvelo-Rivera M,Christie NA,Buenaventura PO,Landreneau RJ.Minimally invasive operation for esophageal diverticula.Ann Thorac Surg 2005;80:2076-2080[PMID:16305847 DOI:10.1016/j.athoracsur.2005.06.007]
7 Varghese TK,Marshall B,Chang AC,Pickens A,Lau CL,Orringer MB.Surgical treatment of epiphrenic diverticula:a 30-year experience.Ann Thorac Surg 2007;84:1801-1809;discussion 1801-1809[PMID:18036889 DOI:10.1016/j.athoracsur.2007.06.057]
8 D'Journo XB,Ferraro P,Martin J,Chen LQ,Duranceau A.Lower oesophageal sphincter dysfunction is part of the functional abnormality in epiphrenic diverticulum.Br J Surg 2009;96:892-900[PMID:19591165 DOI:10.1002/bjs.6652]
9 Bredenoord AJ,Fox M,Kahrilas PJ,Pandolfino JE,Schwizer W,Smout AJ;International High Resolution Manometry Working Group.Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography.Neurogastroenterol Motil 2012;24 Suppl 1:57-65[PMID:22248109 DOI:10.1111/j.1365-2982.2011.01834.x]
10 Sato H,Takahashi K,Mizuno KI,Hashimoto S,Yokoyama J,Hasegawa G,Terai S.Esophageal motility disorders:new perspectives from high-resolution manometry and histopathology.J Gastroenterol 2018;53:484-493[PMID:29134329 DOI:10.1007/s00535-017-1413-3]
11 Fasano NC,Levine MS,Rubesin SE,Redfern RO,Laufer I.Epiphrenic diverticulum:clinical and radiographic findings in 27 patients.Dysphagia 2003;18:9-15[PMID:12497191 DOI:10.1007/s00455-002-0075-2]
12 de Schipper JP,Pull ter Gunne AF,Oostvogel HJ,van Laarhoven CJ.Spontaneous rupture of the oesophagus:Boerhaave's syndrome in 2008.Literature review and treatment algorithm.Dig Surg 2009;26:1-6[PMID:19145081 DOI:10.1159/000191283]
13 Klaus A,Hinder RA,Swain J,Achem SR.Management of epiphrenic diverticula.J Gastrointest Surg2003;7:906-911[PMID:14592666]
14 Rosati R,Fumagalli U,Elmore U,de Pascale S,Massaron S,Peracchia A.Long-term results of minimally invasive surgery for symptomatic epiphrenic diverticulum.Am J Surg 2011;201:132-135[PMID:21167369 DOI:10.1016/j.amjsurg.2010.03.016]
15 Brandeis AE,Singhal S,Lee TH,Mittal SK.Surgical management of epiphrenic diverticulum:A singlecenter experience and brief review of literature.Am J Surg 2018;216:280-285[PMID:28778314 DOI:10.1016/j.amjsurg.2017.06.039]
16 Onwugbufor MT,Obirieze AC,Ortega G,Allen D,Cornwell EE,Fullum TM.Surgical management of esophageal diverticulum:a review of the Nationwide Inpatient Sample database.J Surg Res 2013;184:120-125[PMID:23751803 DOI:10.1016/j.jss.2013.05.036]
17 Inoue H,Minami H,Kobayashi Y,Sato Y,Kaga M,Suzuki M,Satodate H,Odaka N,Itoh H,Kudo S.Peroral endoscopic myotomy(POEM)for esophageal achalasia.Endoscopy 2010;42:265-271[PMID:20354937 DOI:10.1055/s-0029-1244080]
18 Inoue H,Sato H,Ikeda H,Onimaru M,Sato C,Minami H,Yokomichi H,Kobayashi Y,Grimes KL,Kudo SE.Per-Oral Endoscopic Myotomy:A Series of 500 Patients.J Am Coll Surg 2015;221:256-264[PMID:26206634 DOI:10.1016/j.jamcollsurg.2015.03.057]
19 Inoue H,Shiwaku H,Iwakiri K,Onimaru M,Kobayashi Y,Minami H,Sato H,Kitano S,Iwakiri R,Omura N,Murakami K,Fukami N,Fujimoto K,Tajiri H.Clinical practice guidelines for peroral endoscopic myotomy.Dig Endosc 2018;30:563-579[PMID:30022514 DOI:10.1111/den.13239]
20 Sato H,Sato Y,Takeuchi M,Takahashi K,Takeda SR,Inoue H,Kobayashi M.Salvage peroral endoscopic myotomy for esophageal diverticulum.Endoscopy 2015;47 Suppl 1 UCTN:E14-E15[PMID:25603506 DOI:10.1055/s-0034-1390735]
21 Sato H,Sato Y,Hashimoto S,Mizuno K,Nakajima N,Terai S.Gastrointestinal:Salvage peroral endoscopic myotomy for outflow obstruction with growing esophageal diverticulum.J Gastroenterol Hepatol 2016;31:1237[PMID:27059011 DOI:10.1111/jgh.13397]
22 Otani K,Tanaka S,Kawara F,Fujikawa J,Sawada A,Uemura R,Tanigawa T,Watanabe T,Azuma T,Fujiwara Y.Distal esophageal spasm with multiple esophageal diverticula successfully treated by peroral endoscopic myotomy.Clin J Gastroenterol 2017;10:442-446[PMID:28756484 DOI:10.1007/s12328-017-0768-6]
23 Demeter M,Bánov?in P,?uri?ek M,Kunda R,Hyrdel R.Peroral endoscopic myotomy in achalasia and large epiphrenic diverticulum.Dig Endosc 2018;30:260-262[PMID:28884499 DOI:10.1111/den.12961]
24 Yang J,Zeng X,Yuan X,Chang K,Sanaei O,Fayad L,Kumbhari V,Singh V,Kalloo AN,Hu B,Khashab MA.An international study on the use of peroral endoscopic myotomy(POEM)in the management of esophageal diverticula:the first multicenter D-POEM experience.Endoscopy 2019;51:346-349[PMID:30453378 DOI:10.1055/a-0759-1428]
25 Sato H,Takahashi K,Takeuchi M,Sato Y,Hashimoto S,Mizuno K,Terai S.Epiphrenic diverticulum of the esophagus after peroral endoscopic myotomy.Endoscopy 2015;47 Suppl 1 UCTN:E509-E510[PMID:26492299 DOI:10.1055/s-0034-1393232]
26 Badillo R,Francis D,DeVault K.Formation of large esophageal diverticulum after peroral endoscopic myotomy.Gastrointest Endosc 2015;82:962;discussion 963[PMID:26099930 DOI:10.1016/j.gie.2015.05.020]
27 Akintoye E,Kumar N,Obaitan I,Alayo QA,Thompson CC.Peroral endoscopic myotomy:a metaanalysis.Endoscopy 2016;48:1059-1068[PMID:27617421 DOI:10.1055/s-0042-114426]
28 Talukdar R,Inoue H,Nageshwar Reddy D.Efficacy of peroral endoscopic myotomy(POEM)in the treatment of achalasia:a systematic review and meta-analysis.Surg Endosc 2015;29:3030-3046[PMID:25539695 DOI:10.1007/s00464-014-4040-6]
29 Law R,Katzka DA,Baron TH.Zenker's Diverticulum.Clin Gastroenterol Hepatol 2014;12:1773-1782;quiz e111-112[PMID:24055983 DOI:10.1016/j.cgh.2013.09.016]
30 Beard K,Swanstr?m LL.Zenker's diverticulum:flexible versus rigid repair.J Thorac Dis 2017;9:S154-S162[PMID:28446979 DOI:10.21037/jtd.2017.03.133]
31 Watemberg S,Landau O,Avrahami R.Zenker's diverticulum:reappraisal.Am J Gastroenterol 1996;91:1494-1498[PMID:8759648]
32 Yuan Y,Zhao YF,Hu Y,Chen LQ.Surgical treatment of Zenker's diverticulum.Dig Surg 2013;30:207-218[PMID:23838812 DOI:10.1159/000351433]
33 Ishaq S,Sultan H,Siau K,Kuwai T,Mulder CJ,Neumann H.New and emerging techniques for endoscopic treatment of Zenker's diverticulum:State-of-the-art review.Dig Endosc 2018;30:449-460[PMID:29423955 DOI:10.1111/den.13035]
34 Sato H,Takeuchi M,Terai S.Gastrointestinal:Endoscopic diverticulectomy for the treatment of Zenker's diverticulum with a unique"tip":A first case report in Japan.J Gastroenterol Hepatol 2019[PMID:30714200 DOI:10.1111/jgh.14599]
35 Chang CY,Payyapilli RJ,Scher RL.Endoscopic staple diverticulostomy for Zenker's diverticulum:review of literature and experience in 159 consecutive cases.Laryngoscope 2003;113:957-965[PMID:12782805 DOI:10.1097/00005537-200306000-00009]
36 Smith SR,Genden EM,Urken ML.Endoscopic stapling technique for the treatment of Zenker diverticulum vs standard open-neck technique:a direct comparison and charge analysis.Arch Otolaryngol Head Neck Surg 2002;128:141-144[PMID:11843721]
37 Baldwin DL,Toma AG.Endoscopic stapled diverticulotomy:a real advance in the treatment of hypopharyngeal diverticulum.Clin Otolaryngol Allied Sci 1998;23:244-247[PMID:9669074]
38 Counter PR,Hilton ML,Baldwin DL.Long-term follow-up of endoscopic stapled diverticulotomy.Ann RColl Surg Engl 2002;84:89-92[PMID:11995771]
39 Vogelsang A,Preiss C,Neuhaus H,Schumacher B.Endotherapy of Zenker's diverticulum using the needle-knife technique:long-term follow-up.Endoscopy 2007;39:131-136[PMID:17041841 DOI:10.1055/s-2006-944657]
40 Charles T,Sturgeon MD.Esophageal diverticula.JAMA 1929;92:379-385[DOI:10.1001/jama.1929.02700310025008]
41 SCHICK A,YESNER R.Traction diverticulum of esophagus with exsanguination:report of a case.Ann Intern Med 1953;39:345-349[PMID:13080892]
42 Ferreira LE,Simmons DT,Baron TH.Zenker's diverticula:pathophysiology,clinical presentation,and flexible endoscopic management.Dis Esophagus 2008;21:1-8[PMID:18197932 DOI:10.1111/j.1442-2050.2007.00795.x]
43 Siddiq MA,Sood S,Strachan D.Pharyngeal pouch(Zenker's diverticulum).Postgrad Med J 2001;77:506-511[PMID:11470929]
44 Bizzotto A,Iacopini F,Landi R,Costamagna G.Zenker's diverticulum:exploring treatment options.Acta Otorhinolaryngol Ital 2013;33:219-229[PMID:24043908]