Endoscopic Treatment of Zenker´s diverticula and cricopharyngeal bar with a novel super pulsed Thulium fiber laser

Aims Electrosurgery is the standard for endoscopic interventions in Zenker's diverticula (ZD) and cricopharyngeal bar (CB). This case series explores the application of a Thulium fiber laser (TFL) as an alternative modality. This study assesses the feasibility and effectiveness of a 1920nm super pulsed TFL in treating ZD and CB.

Methods We retrospectively analyzed 8 patients treated at Haukeland University Hospital from November 2022 to August 2023, monitoring both acute and delayed postoperative outcomes and treatment efficacy. Procedures were conducted under general anesthesia or deep sedation, utilizing a 365 or 550 micron TFL fiber with a 4.5-7 Fr triple-lumen cannula for enhanced fiber stability. Physiological saline was employed for irrigation, with energy settings ranging from 10-25W.

Results The cohort comprised five males and three females, all symptomatic for ZD and CB but ineligible for surgical intervention due to rigid necks or significant comorbidities. The average age was 81 years. The mean procedure duration was 57 minutes. One non-intubated patient developed postoperative pneumonia, but no other acute or delayed complications were observed. All patients exhibited improvement in dysphagia at follow-up. The same instrument was used for all procedural steps in every case.

Conclusions The use of TFL in the endoscopic treatment of ZD and CB appears to be a viable option. Its benefits include reduced CO2 usage, high precision, and effective tissue ablation. The laser's fiber size and properties are particularly advantageous for confined anatomical spaces. However, a learning curve and specific accessories are requisite for optimal use. Further research is necessary to substantiate these preliminary findings.

 

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Conflicts of interest

Pham KDC is consultant, speaker and trainer for Olympus EMEA

Publication History

Article published online:
15 April 2024