Introduction Flexible endoscopic septum division is a well established and safe approach for the treatment of Zenker’s diverticulum (ZD). The main downside of this approach is the high rate of relapsing patients, regardless of the devices and techniques employed. We have developed a new technique for ZD endotherapy in which a wider part of the diverticular septum is excised. It is aimed at improving both the short-term efficacy of the procedure and the long term results.
Method 21 consecutive patients with a symptomatic ZD and did not receive previous treatments were included in this study. Demographic and clinical data were collected. All patients were treated with our new technique. Briefly, two parallel incisions, about 1 cm deep and 1.5 cm apart from each other, are performed on the septum, and a polypectomy snare is then used to remove the septum in between. Two to three clips are then positioned to prevent mucosal dissection at the site of the incision (Figure 1). Any complications that developed during the procedure were recorded. The patients were contacted 2 and 6 months after the procedure, and were advised to contact us if symptoms relapsed/worsened afterwards.
Results Before treatment 19 patients (90.48%) had dysphagia, 17 (80.95%) had regurgitation and 17 (80.95%) had aspiration. All procedures were carried out without complications. After treatment 15 patients (71.4%) had a complete symptom remission and 6 (28.6%) reported a substantial improvement. Of these, 3 refused further treatments and 3 underwent another treatment which led to symptom remission in 2 patients and to a further improvement in one. The median follow-up was 15 months (IQR 8, range 8–31). Two patients (9.5%) had relapsing symptoms (at 8 and 11 months from treatment) and underwent a further treatment that led to an almost complete symptom remission in both.
Conclusion Double incision septum division is a safe and effective procedure for ZD endotherapy. Our preliminary results suggests that it yields better long term results, with a reduced relapse rate in comparison to the standard technique. Further studies are needed to fully assess the efficacy and safety of this technique.
Disclosure of interest None Declared.
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