Alan H. Tieu, MD, from the Department of Medicine, Division of Gastroenterology and Hepatology, at The Johns Hopkins University School of Medicine in Baltimore, Maryland, USA shares this video case “Flexible endoscopic Zenker’s diverticulotomy.”
We demonstrate a technique of flexible endoscopic diverticulotomy for management of Zenker’s diverticulum (ZD). A 73-year-old male presents with dysphagia, regurgitation, weight loss, and recurrent aspiration pneumonia. The patient had prior rigid endoscopic diverticulotomy 5 years earlier with short-term relief. The procedure was performed under conscious sedation with propofol. A needle knife was used to sever the septum (cricopharyngeal muscle) between the esophageal lumen and diverticulum. The patient was discharged the following day and recommenced a soft diet. At the 6-month follow-up visit, the patient remained well with minimal symptoms and without episodes of aspiration pneumonia.
In this video, we successfully demonstrate the use of flexible endoscopic diverticulotomy in a patient that had relapsed post rigid endoscopic diverticulotomy. This technique successfully reduces cricopharyngeal sphincter pressure and can be performed safely by endoscopists with training in advanced endoscopy. Flexible endoscopic approach has been shown to be comparable to a rigid transoral diverticulotomy in terms of safety and efficacy.
Flexible endoscopic intervention may be most suitable for elderly patients with comorbid medical conditions limiting surgical intervention. The advantages of a flexible endoscopic approach are the flexibility and smaller endoscope diameter, which are especially useful for patients with poor neck extension and/or limited jaw retraction. We believe expert endoscopists can perform ZD therapy effectively and safely.
Flexible endoscopic diverticulotomy requires a thorough knowledge of neck anatomy, well-experienced endoscopic skill, and understanding of basic surgical principles.
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