A NOVEL GRASPING-TYPE SCISSORS FORCEPS ALLOWS FOR FAST, SAFE AND EFFECTIVE ENDOSCOPIC MYOTOMY IN PATIENTS WITH ZENKER'S DIVERTICULUM

Aims:

Several endoscopic techniques have been described for Zenker's diverticulotomy; however, no standardized endoscopic approach has been routinely established yet. This study aimed to assess the efficacy and safety of endoscopic diverticulotomy using the Clutch Cutter (CC) as a novel grasping-type scissors forceps.

Methods:

In 7 prospectively enrolled patients (4 female, 3 male, mean age 78 years) with symptomatic Zenker's diverticulum (ZD), cricopharyngeal myotomy was performed using a standardized protocol with the CC. Procedural details such as duration, complications and technical success were recorded. Prior to endoscopic diverticulotomy, barium swallow enema was performed to assess size and radiologic classification

Results:

All patients had a esophageal compression by the ZD, equaling grade 4 on the Brombart scale. Myotomy with the CC was feasible in all 7 patients with a technical success rate of 100%. Complete diverticulotomy was achieved in a single session in all patients. Mean procedure time of the diverticulotomy with the CC was 19 minutes (range 10 to 30 minutes). There were no major complications such as obvious perforation or severe bleeding requiring re-intervention. In one patient, minor bleeding during myotomy occurred which could be immediately stopped during the procedure through coagulation with the closed CC. Mean hospital stay was 3 days (range 2 to 4 days). All patients had symptom relief after myotomy with the CC. During a mean follow-up of 14 months, a single patient experienced a diverticulum recurrence 10 months after the initial myotomy which was then successfully treated with a second diverticulotomy with the CC.

Conclusions:

Endoscopic diverticulotomy using the Clutch Cutter is safe, effective and fast. Larger studies comparing myotomy with the Clutch Cutter with other endoscopic techniques are highly warranted.