Transoral flexible endoscopic therapy of Zenker's diverticulum: is it time for gastroenterologists to stick their necks out?

can also be performed without the use of general anesthesia in many instances. A transoral flexible endoscopic approach successfully reduces cricopharyngeal sphincter pressure [6] . The septum can be divided with a variety of cutting instruments and accessories. It is unknown whether a transoral flexible endoscopic approach will show longterm results compared to rigid surgical therapy for long-term relief of symptoms. In one recent study in which 94% of patients underwent transoral rigid endoscopic therapy, durable relief of symptoms was noted in only ~40% of the cases (including recurrences) [7] . One limitation of the currently available flexible endoscopic data is the paucity of quality patient follow-up. In evaluation of the available studies, nearly one third demonstrate inadequate postprocedure follow-up. However, with improvements in techniques and technologies, we believe a complete myotomy can be achieved safely and effectively using a flexible transoral approach. Dear Sir, We read with interest the excellent article on surgical treatment of Zenker’s diverticulum (ZD) by Yuan et al. [1] . However, their citations on flexible endoscopic management of ZD are lacking. They cite only two articles from the initial description of flexible therapy of ZD from nearly 20 years ago. Since those two original descriptions, over 15 series involving more than 600 patients have been published [2–4] . Overall, the results of flexible therapy compare favorably to rigid endoscopic therapy. Indeed, one article retrospectively compared flexible and rigid endoscopic therapy showing similar outcomes [5] . Flexible endoscopic procedures are usually performed by gastroenterologists or surgical endoscopists in the endoscopy suite, whereas rigid endoscopic procedures are performed by surgeons in the operating room. The advantages of a flexible endoscopic approach rest in a wider visual field and flexibility and smaller endoscope diameter, which are especially useful for patients with poor neck extension and/or limited jaw retraction. It Published online: October 29, 2013