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DOI: 10.1055/s-0043-123644
Double incision and snare resection in symptomatic Zenker’s diverticulum: a modification of the stag-beetle knife technique
Publikationsverlauf
Publikationsdatum:
29. Januar 2018 (online)
![](https://www.thieme-connect.de/media/endoscopy/201802/lookinside/thumbnails/16107_10-1055-s-0043-123644-1.jpg)
We read with great interest the article entitled “Double incision and snare resection in symptomatic Zenker’s diverticulum: a modification of the stag beetle knife technique” by Gölder et al. [1]. Although not acknowledged or cited, this appears to be an adaptation of the double-incision and snare technique first described by our group [2].
This is what we described: two parallel incisions were made to dissect the mucosa and the horizontal fibers of the cricopharyngeal muscle using the SB Knife (Sumitomo Bakelite Ltd., Tokyo, Japan); a monopolar snare was used to remove the portion of the septum in between. Endocut currents were used throughout the procedure (VIO 200D; ERBE Electromedizin, Tübingen, Germany). The depth of the incision was variable from patient to patient, dependent on the size of the diverticulum, and was balanced to achieve a near-complete cricopharyngeal myotomy but without the risk of perforation. Two or three clips (Clip HX-610-090L; Olympus, Tokyo, Japan) were deployed at the site of the incision to prevent mucosal dissection and perforation ([Fig. 1]). There was no further dissection of the cricopharyngeal muscle, as this had already been resected with the snare.
![](https://www.thieme-connect.de/media/endoscopy/201802/thumbnails/10-1055-s-0043-123644-i16107en1.jpg)
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What Gölder et al. describe is a suboptimal version of our technique in which two parallel incisions are carried out and the mucosa between the incisions and some of the muscle fibers are snared; dissection of the cricopharyngeal muscle is then performed afterward [1]. This is no different to the single-incision technique, which is commonly used, as it does not physically remove the septal wall to improve the emptying of the diverticular pouch, as is described in our technique.
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References
- 1 Gölder SK, Brueckner J, Ebigbo A. et al. Double incision and snare resection in symptomatic Zenker’s diverticulum: a modification of the stag beetle knife technique. Endoscopy DOI: 10.1055/s-0043-119286.
- 2 Battaglia G, Antonello A, Realdon S. et al. Flexible endoscopic treatment for Zenker’s diverticulum with the SB Knife. Preliminary results from a single-center experience. Dig Endosc 2015; 27: 729-734