Flexible endoscopic Septum division for Zenker’s diverticulum: Diagnosis and follow-up

Background A pharyngeal pouch or Zenker’s diverticulum (ZD) is a mucosal out-pouching in the cervical oesophagus. It arises from the posterior oesophageal wall in a structural weakness between horizontal and oblique cricopharyngeus fibre known as Killian’s dehiscence located between the oblique and horizontal muscle fibre layers of the Cricopharyngeus (CP) muscle Killian.The aim of the treatment is to provide symptom relief and improve quality of life. Literature on ZD consisted of small series, retrospective studies. With wide variation in the procedure technique using different cutting Devices. Some experts would use general anaesthesia, some use Propofol, or midazolam. There was variation in use of clips, antibiotics to be used. Methods and results We looked at the deficiencies in the knowledge that that provided the justification to start our research on treatment of Zenker’s diverticulum. We carried out the first systematic review and meta-analysis (MA) of the literature focusing on Flexible Endoscopic Septum Division (FESD) for Zenker’s diverticulum including in-depth evaluation of its efficacy safety and limitation. WE introduced new comprehensive symptom scoring tool that we validated in prospective study. We explored the incidence and aetiology of intubation failure in endoscopy to assess the predictors of intubation failure and predictors of pathology in patient’s pharyngeal symptoms. We introduced concept of two stage sedation using HFNOT in a prospective observational study. We conducted the first study with large number of patient with longest follow up and looked at the predictors of recurrence. Conclusion Our studies on all aspects of ZD to address gaps in literature but also highlighted implication for future research