Post written by Sanjay Palat, MD, from Internal Medicine, Washington University in St. Louis, St. Louis, Missouri, USA.

This case involves a 65-year-old man with a Zenker diverticulum that recurred after 2 unsuccessful surgeries, transoral staple myotomy and revisional transcervical cricopharyngeal myotomy. He noted the recurrence of dysphagia, regurgitation, and weight loss beginning 1 month after his second surgery.

Our video demonstrates the use of a common technique for endoscopic septotomy of the Zenker diverticulum but for a recurrent and fibrosed Zenker diverticulum.

With this technique, we use a scissor-type electrocautery knife (SB Knife Junior; Olympus America, Center Valley, Pa, USA) to allow for safe septotomy. We encountered fibrosis and retained staples from prior surgery using rat-tooth endoscopy forceps. Minimal bleeding was observed, but hemostatic clips were placed to reduce postprocedural bleeding risk and leak.

The next day, esophagogram revealed improved contrast flow. One year after his procedure, the patient continues to report full resolution of his symptoms.

We feel that the video shows that endoscopic septotomy is a safe and effective technique for endoscopic management of recurrent Zenker diverticula refractory to surgical management. Despite the presence of scarring and staples from prior surgical interventions, we encountered a safe dissection plane similar to what we would expect to find in a patient without prior interventions. Clinically, the patient had an excellent and durable response to the procedure with no recurrence in symptoms.

This case illustrates that, in addition to being weighed as initial therapy, endoscopic septotomy is safe and should be considered in patients with recurrent Zenker diverticula refractory to surgical interventions.

A scissor-type electrocautery knife (SB Knife Junior; Olympus America, Central Valley, Pa, USA) was used to perform the septotomy. Orogastric tube was visible in the true lumen.

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