Double incision and snare resection in symptomatic Zenker’s diverticulum: a modification of the stag beetle knife technique
submitted 19 May 2017
accepted after revision 10 August 2017
27 September 2017 (eFirst)
Background and study aim Relief from dysphagia and regurgitation are the main goals of therapy in symptomatic Zenker’s diverticulum. Flexible endoscopic treatment has proved to be an effective and safe method in control of these symptoms. The aim of our study was to further improve the resection of the cricopharyngeal muscle using a new technique, the double incision and snare resection (DISR) procedure, to reduce the recurrence rate.
Patients and methods From February 2016 to April 2017, 16 patients were treated with 18 DISR procedures at our institution. The symptoms of the patients were recorded by a seven-item questionnaire prior to treatment, and re-evaluation was scheduled at 1 and 6 months after treatment.
Results The median age was 70 years (range 55 – 85), and 10 patients were men (62 %). The median size of the diverticulum was 20 mm (range 5 – 40 mm), and the DISR procedure was performed in 28 minutes (range 20 – 47 minutes), with no major postinterventional complications. All patients re-started oral nutrition on the day after the intervention; a gastric tube was not required. The median follow-up was 3 months (range 1 – 15 months). Two patients received a planned second-step procedure, one because of a very large cricopharyngeal muscle and one because of a cyst inside the Zenker’s bridge. Although one patient suffered from mild recurrence of symptoms, she refused a second treatment. All other patients were free of symptoms after treatment.
Conclusions The DISR procedure is a new endoscopic treatment technique that safely and reproducibly offers relief from symptomatic Zenker’s diverticulum.
- 1 Repici A, Pagano N, Fumagalli U. et al. Transoral treatment of Zenker diverticulum: flexible endoscopy versus endoscopic stapling. A retrospective comparison of outcomes. Dis Esophagus 2011; 24: 235-239
- 2 Albers DV, Kondo A, Bernardo WM. et al. Endoscopic versus surgical approach in the treatment of Zenker’s diverticulum: systematic review and meta-analysis. Endosc Int Open 2016; 4: E678-686
- 3 Costamagna G, Iacopini F, Bizzotto A. et al. Prognostic variables for the clinical success of flexible endoscopic septotomy of Zenker’s diverticulum. Gastrointest Endosc 2016; 83: 765-773
- 4 Brueckner J, Schneider A, Messmann H. et al. Long-term symptomatic control of Zenker diverticulum by flexible endoscopic mucomyotomy with the hook knife and predisposing factors for clinical recurrence. Scand J Gastroenterol 2016; 51: 666-671
- 5 Goelder SK, Brueckner J, Messmann H. Endoscopic treatment of Zenker’s diverticulum with the stag beetle knife (sb knife) – feasibility and follow-up. Scand J Gastroenterol 2016; 51: 1155-1158
- 6 Ong CC, Elton PG, Mitchell D. Pharyngeal pouch endoscopic stapling – are post-operative barium swallow radiographs of any value?. J Laryngol Otol 1999; 113: 233-236
- 7 Feussner H. Reducing treatment of Zenkers diverticulum to the essentials: the flexible endoscopic approach. Endoscopy 1995; 27: 445
- 8 Costamagna G, Iacopini F, Tringali A. et al. Flexible endoscopic Zenkers diverticulotomy: cap-assisted technique vs. diverticuloscope-assisted technique . Endoscopy 2007; 39: 146-152
- 9 Evrard S, Moine OL, Hassid S. et al. Zenker’s diverticulum: a new endoscopic treatment with a soft diverticuloscope. Gastrointest Endosc 2003; 58: 116-120
- 10 Repici A, Pagano N, Romeo F. et al. Endoscopic flexible treatment of Zenker’s diverticulum: a modification of the needle-knife technique. Endoscopy 2010; 42: 532-535
- 11 Shah RN, Slaughter KA, Fedore LW. et al. Does residual wall size or technique matter in the treatment of Zenker’s diverticulum?. Laryngoscope 2016; 126: 2475-2479
- 12 Visser LJ, Hardillo JA, Monserez DA. et al. Zenker’s diverticulum: Rotterdam experience. Eur Arch Otorhinolaryngol 2016; 273: 2755-2763
- 13 Gutschow CA, Hamoir M, Rombaux P. et al. Management of pharyngoesophageal (Zenker’s) diverticulum: Which technique?. Ann Thorac Surg 2002; 74: 1677-1683