Endoscopy 2010; 42(7): 532-535
DOI: 10.1055/s-0029-1244163
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic flexible treatment of Zenker's diverticulum: a modification of the needle-knife technique

A.  Repici1 , N.  Pagano1 , F.  Romeo1 , S.  Danese1 , M.  Arosio1 , G.  Rando1 , G.  Strangio1 , A.  Carlino1 , A.  Malesci1
  • 1Department of Gastroenterology, Digestive Endoscopy Unit, IRCCS Istituto Clinico Humanitas, Milano, Italy
Further Information

Publication History

submitted 12 December 2009

accepted after revision 25 January 2010

Publication Date:
30 June 2010 (online)

Background and study aim: Endoscopic treatment of Zenker's diverticulum has been successfully reported over the last 10 years using different approaches. The hook-knife is a new device originally developed for endoscopic submucosal dissection procedures. This study aimed to investigate the safety and efficacy of endoscopic myotomy performed with the hook-knife.

Patients and method: From July 2005, 32 consecutive patients (23-male, mean age 74.8 years) with dysphagia secondary to the presence of Zenker's diverticulum were prospectively enrolled. Myotomy was performed using a straight-end transparent hood to the tip of the scope and the hook-knife for the incision of the bridge between the Zenker's diverticulum and the esophagus. Clinical outcome was evaluated assigning a dysphagia symptom score from 0 (symptoms absent) to 4 (inability to swallow saliva).

Results: General anesthesia was used in 4 patients, deep sedation with propofol in 23 patients, while midazolam was used in 5 patients. The mean procedural time was 28 minutes. Complications occurred in 2 patients (6.25 %). At 1 month follow-up, the mean dysphagia score was significantly improved from 2.9 to 0.6 (P < 0.001) with 87.5 % of patients free of symptoms and 4 patients with dysphagia that was persistent but milder than before the treatment. Three of these 4 patients underwent a successful second endoscopic treatment with complete relief of dysphagia; one was not re-treated because of advanced age (92 years). During the follow-up period (23.87 ± 9.6 months), 2 patients developed dysphagia recurrence. The overall success rate was 90.6 %.

Conclusions: Diverticulectomy with a flexible scope and the hook-knife may represent a safe and effective alternative treatment for patients with Zenker's diverticulum.


A. Repici, , MD 

Digestive Endoscopy Unit
Istituto Clinico Humanitas

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