EFFICACY AND SAFETY OF THE ENDOSCOPIC SEPTOSTOMY OF ZENKER'S DIVERTICULUM WITH THE SB-KNIFE

Aims Management of Zenker's diverticulum (ZD) through open neck surgery to perform a cricopharyngeal myotomy ,and stapling through rigid endoscopes have been the standard treatments in past decades. Several endoscopic techniques have been developed. We present our experience of Zenker's diverticulotomy (ZS) using a flexible endoscope and an SB-knifeTM (Sumitomo Bakelite Ltd., Japan), primaily designed for ESD.

Methods From February 2017 to October 2021 we prospectively collected the data of our first 22 ZS performed with an SB-knife. Inclusion criteria:>18 years, symptomatic ZD diagnosed by esophagogram, CT or endoscopy, and no previous treatment. All patients signed informed consent. All procedures performed under general anesthesia and antibiotic prophylaxis, using: duck-bill diverticuloscope (Cook Endoscopy, Winston-Salem, NC, USA), stiff guidewire, flexible Fujinon videoscopes and VIO200/300 (ERBE Elektromedizin, Tübingen, Germany) electrosurgical units. Efficacy, safety and hospital stay were tested.

Results Twenty-two septostomies in 18 patients (16 male), aged 67.5, sized 37.5 (17-62) mm. Treatment completion: 100% in 29.6 minutes, using 2.4 clips. Adverse events: 1 mild haemorrhage (endoscopic tx); 1 fever (normal CT); no perforations. No surgery/death. Mean f-up: 387 days. In 21/22 patients the symptoms improved or relieved immediately. Four patients relapsed after 5.75 months, and were retreated (1 unsuccesful, submitted to surgery.) Eckardt score decreased from 5.3 to 0.5. Global long-time clinical success 21/22 (95.4%); . Mean hospital stay: 2.0 days.

Conclusions Endoscopic diverticulotomy with the SB-knife is safe, feasible and effective; with an Eckardt scale decrease from 5.3 to 0.5. Longterm global clinical success achieved 95% after retreating 4 recurrences; Adverse events rate was negligible.

Publication History

Article published online:
14 April 2022