Flexible endoscopic treatment for Zenker’s diverticulum (ZD) focuses on releasing the cricopharyngeal spasm by performing diverticulotomy on the septum. Current flexible endoscopic devices and techniques in ZD treatment require advanced endoscopic expertise and skills. Dedicated devices for directed and expedited septal dissection are lacking. This study aimed to develop and test prototypes for flexible endoscopic diverticulotomy.
An in vivo flexible endoscopic diverticulotomy was performed in a nonsurvival swine model (n = 6; 110-lb animals). Two iterations of the diverticulotomy device were used to perform the diverticulotomy: a diverticulum cap with a swinging needleknife and a diverticulotome or septotome. The diverticulotome consisted of a diverticulum cap and a built-in cutting wire. The study evaluated the feasibility and efficiency of septal dissection with these devices.
Efficient (<1–2 min) midline septal dissection was achieved using both devices without failure or immediate bleeding. A diverticulum cap with a swinging needleknife provides targeted and more precise septal dissection than a diverticulotome. The diverticulotome requires higher power settings due to the wider contact area between the septal tissues and the cutting wire.
Flexible endoscopic diverticulotomy is feasible and efficient using the aforementioned diverticulotomy devices. The techniques in diverticulotomy using these devices are similar to those in biliary sphincterotomy using a sphincterotome, endoscopic needleknife, or both.
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Van Overbeek JJ (2003) Pathogenesis and methods of treatment of Zenker’s diverticulum (review). Ann Otol Rhinol Laryngol 112:583–593
Tang SJ, Myers LL (2010) Flexible endoscopic diverticulotomies for bilateral Zenker’s diverticula (with videos). Laryngoscope 20:1553–1556
Tang SJ, Bhaijee F, Daram SR (3013) Posttraumatic pseudo-Zenker’s diverticulum (with videos). Esophagus 10:30–33
Tang SJ, Tang L, Chen E, Myers LL (2008) Flexible endoscopic Killian-Jamieson’s diverticulotomy (with video) and literature review. Gastrointest Endosc 68:790–793
Collard JM, Otte JB, Kestens PJ (1993) Endoscopic stapling technique of esophagodiverticulostomy for Zenker’s diverticulum. Ann Thoracic Surg 56:573–576
Whited C, Lee WT, Scher R (2012) Evaluation of endoscopic harmonic diverticulostomy. Laryngoscope 122:1297–1300
Vogelsang A, Preiss C, Neuhaus H, Schumacher B (2007) Endotherapy of Zenker’s diverticulum using the needleknife technique: long-term follow-up. Endoscopy 39:131–136
Huberty V, El Bacha S, Blero D, Le Moine O, Hassid S, Devière J (2013) Endoscopic treatment for Zenker’s diverticulum: long-term results (with video). Gastrointest Endosc 77:701–707
Katzka DA, Baron TH (2013) Transoral flexible endoscopic therapy of Zenker’s diverticulum: is it time for gastroenterologists to stick their necks out? (editorial). Gastrointest Endosc 77:708–710
Sakai P (2007) Endoscopic treatment of Zenker’s diverticulum (editorial). Gastrointest Endosc 65:1054–1055
Tang SJ (2013) Flexible endoscopic Zenker’s diverticulotomy using needleknife. Video J Encyclopedia GI Endosc 1:75–78. doi:10.1016/S2212-0971(13)70034-7
Tang SJ, Jazrawi S, Chen E, Tang L, Myers LL (2008) Flexible endoscopic clip-assisted Zenker’s diverticulotomy (with videos): the first case series. Laryngoscope 118:1199–1205
Tang SJ, Lara LF (2008) Flexible endoscopic clip-assisted Zenker’s diverticulotomy (with video). Gastrointest Endosc 67:704–708
Seaman DL, de la Mora Levy J, Gostout CJ, Rajan E, Herman L, Knipschield M (2007) An animal training model for endoscopic treatment of Zenker’s diverticulum. Gastrointest Endosc 65:1050–1053
Shou-jiang Tang has no conflicts of interest or financial relationships to disclose.
About this article
Cite this article
Tang, S. Flexible endoscopic Zenker’s diverticulotomy: approach that involves thinking outside the box (with videos). Surg Endosc 28, 1355–1359 (2014) doi:10.1007/s00464-013-3335-3
- Zenker’s diverticulum
- Divertculum cap