Endoscopy 2019; 51(04): S181-S182
DOI: 10.1055/s-0039-1681708
ESGE Days 2019 ePoster podium presentations
Saturday, April 6, 2019 13:00 – 13:30: Zenker ePoster Podium 8
Georg Thieme Verlag KG Stuttgart · New York

A NEW OPTION IN ZENKER'S DIVERTICULUM ENDOSCOPIC TREATMENT

I Cunha
1   Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
,
P Amaro
1   Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
,
E Gravito-Soares
1   Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
,
M Gravito-Soares
1   Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
,
L Tomé
1   Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

The endoscopic treatment of Zenker's diverticulum (ZD) consists in the division of the septum that separates the diverticulum from the cervical oesophagus, a structure that includes the cricopharyngeal muscle. This septotomy is not yet standardized and may be performed using a variety of techniques and devices, from coagulation with argon-plasma to incision with forceps or diathermic knives, with variable efficacy, rate of complications and symptomatic recurrence. The aim of this study is to assess the efficacy and safety of a new endoscopic option in ZD treatment.

Methods:

Prospective case series of patients who underwent cricopharyngeal myotomy using the ClutchCutter, a novel grasping-type scissors. Procedural details, complications, technical and clinical success rates were recorded. Clinical success was defined according to a score evaluating the weekly frequency of ZD-related symptoms (dysphagia, regurgitation, diurnal and/or nocturnal respiratory symptoms). A clinical score ≥2 after treatment defines clinical failure (until 6 months) or recurrence (after 6 months).

Results:

11 patients (82% men; mean age of 74 ± 10 years-old), 5 naïve-ZD patients and 6 symptomatic relapses after primary treatment with grasping-forceps (Hotclaw) were treated with ClutchCutter. Mean size of ZD before the treatment was 32 ± 7 mm for naïve-ZD and 13 ± 0,5 mm for symptomatic relapses. All procedures were performed without complications. During a short-term follow-up (4 ± 2months) only one patient, with several previous failed treatments, had symptomatic failure.

Conclusions:

The ClutchCutter was developed for submucosal dissection of superficial neoplasms of the gastrointestinal tract. Our results suggest that this electrosurgical device may also be applied in flexible endoscopic Zenker's diverticulotomy, either treatment-naïve or patients with recurrence, as an easy, fast, safe and efficient alternative endoscopic modality. These results must be validated in a larger series with a longer follow-up.