Post written by Ryan Law, DO, from the Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.

A 41-year-old woman presented with a 2-year history of nausea, post-prandial pain, dysphagia to solid food, and intermittent regurgitation. During her evaluation, she was found to have a 4-cm long outpouching suggestive of an epiphrenic diverticulum as well as an intraluminal duodenal diverticulum (ie, windsock diverticulum) in the second portion of the duodenum. While her dysphagia was felt to be unrelated to the windsock diverticulum, it seemed plausible that her other symptoms may be related to this unexpected finding. She subsequently underwent endoscopic diverticulotomy using novel endoscopic submucosal dissection scissors (SB knife, Olympus America, Center Valley, PA).

This video demonstrates a rare but important clinical entity that most endoscopists have never encountered. Additionally, we demonstrate the use of a novel device to incise the diverticular free wall. There are many take home points from our video: 1) windsock diverticulum often arise in the second portion of the duodenum, thus the ampulla needs to be identified prior to intervention; 2) windsock diverticulum are very vascular entities and are prone to bleed during incision/excision, though we were fortunate in our case; and 3) there are many ways to skin a cat with our case adding to the armamentarium of prior techniques and tools described in the literature.

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