PERORAL ENDOSCOPIC SEPTOTOMY (POES): A NOVEL ENDOSCOPIC APPROACH TO ZENKER'S DIVERTICULUM

Aims:

Zenker's diverticulum (ZD) arises as a result of an increased intraluminal pressure in the esophagus caused by the impaired relaxation of the cricopharyngeal muscle. Treatments aim to dissect the muscle in order to remove the underlying dysfunctional condition. Patients with short septum (≤2 cm) diverticulum represent a difficult to be treated subgroup of patients because of the anatomical space limitations leading to reduced operation space either for rigid and flexible endoscopic treatments. The aim of this video is to report an alternative procedure, called Per-oral endoscopic septotomy (POES) proposed to treat short-septum symptomatic ZD.

Methods:

The POES technique consisted of a 15 mm mucosotomy performed at the top of the diverticular septum, after submucosal injection.

Results:

A 68 year-old man was referred to our center for a 20 mm ZD. The procedure was carried out using a 9.3 mm diameter gastroscope with cap (Video 1). After submucosal injection with saline and methylene blue, a 15 mm mucosal incision was performed at the top of the diverticular septum. The underlying submucosa was dissected to create an endoscopic window to visualize the muscular septum. The muscular septum was dissected along its entire length through the mucosal window, sparing the mucosa of both the luminal and the diverticular side. Finally, the mucosal incision was closed with clips. No intra nor post-procedural adverse events occured. After the procedure, an esophagogram was performed showing no contrast stagnation or leak. No dysphagia nor regurgitation were referred at 1 months follow up.

Conclusions:

This approach may be considered an alternative for the treatment of short ZD.