Introduction Zenker’s diverticulum is a mucosal outpouching through the posterior pharyngeal wall resulting from increased hypopharyngeal pressure. Symptoms may include dysphagia and regurgitation of food. Treatment consists of myotomy of the cricopharyngeus muscle, which is commonly done through an endosurgical approach using a rigid endoscope. We describe a novel method of endoscopic diverticulotomy using a flexible diverticuloscope and an endoscopic knife.
Methods With the patient under general anaesthesia, a guidewire is inserted under direct vision into the oesophageal lumen through a gastroscope. The gastroscope is removed and the guidewire is threaded through a hole on the long flap of the flexible diverticuloscope (ZD overtube, ZDO-22 _ 30;Cook Endoscopy, Winston-Salem, North Carolina). The overtube is gently advanced to 20cm until resistance is felt. The gastroscope is then inserted through the overtube and its position adjusted so that the longer flap is in the true oesophageal lumen and the shorter flap is in the diverticulum. The septum is now clearly visualised and stable between the two flaps.
A 3 mm needle-knife is used to incise the septum. The cut is performed until the muscle fibres are completely cut, and then the cut is extended to a section of the anterior diverticulum and posterior oesophageal wall up to approximately 1 cm from the bottom. At the end of the procedure, one to three endoclips are placed to prevent perforation or bleeding.
Results We have performed this procedure in 3 patients. 1 patient had no previous surgical intervention, 1 had recurrence following previous surgical diverticulotomy, and 1 patient had severe cervical spondylosis due to which surgery could not be performed as adequate extension of the neck for the surgical procedure was not possible. There have been no complications.
Conclusion Endoscopic Zenker’s diverticulotomy can be safely performed using a flexible diverticuloscope. We demonstrate the feasibility of performing endoscopic diverticulotomy in patients with recurrence after surgery, or in those who are unsuitable for surgery. We aim to illustrate the principles and technique of this procedure by video demonstration.
Disclosure of Interest None Declared.