Stefano Siboni, MD, Alberto Aiolfi, MD, Chiara Ceriani, MD, Marco Sozzi, MD, Luigi Bonavina, MD, FACS. IRCCS Policlinico San Donato
Aims. Flexible endoscopic treatment of Zenker’s diverticulum is feasible, but electrocautery and CO2 laser technology carry the risk of collateral thermal injury. Thulium laser septum incision may overcome this limitation. We describe for the first time the use of thulium laser through flexible endoscopy in a small cohort of patients with Zenker diverticulum.
Methods. Thulium laser septum division was performed via flexible endoscopy under general anesthesia in 7 consecutive symptomatic patients with primary or recurrent Zenker diverticulum. Primary study aims were feasibility and safety of the procedure. To improve exposure and stabilize the septum during the procedure, either a transparent cap or a bivalved soft overtube were used. The laser system used was Opera® (Quanta System SpA, Varese, Italy), emitting a 1.9 μm Thulium wavelength radiation. A continuous laser configuration and an emission power of 5 to 16 W were chosen to allow incision of the mucosa and cricopharyngeal myotomy. Using 272 and 365 μm optical fibres in a non-contact mode, laser incision was performed in the midline of the septum until cricopharyngeal muscle fibers were encountered and a V-shaped myotomy was completed under visual control.
Results. Between May and October 2017, 7 consecutive patients were treated. Four patients presented with recurrent symptomatic diverticulum after previous transoral septum stapling or endoscopic myotomy. Median dysphagia and regurgitation scores were 3.9 ± 0.7 and 3.0 ± 0.8 respectively. Complete division of the septum was achieved in all patients. There was no bleeding nor need of adjunctive electrocautery devices to complete the procedure. The post-operative course was uneventful in all patients; the chest film and gastrographin swallow study on post-operative day one were negative for pneumomediastinum or leaks. All patients were discharged within 48 hours on a soft diet. At the 2-month follow-up visit, all patients were satisfied with the procedure with a post-operative dysphagia score of 2.1 ± 0.7 and a regurgitation score of 1.6 ± 0.5.
Conclusions. Division of Zenker’s septum with Thulium laser is feasible and safe through flexible endoscopy. Longer term follow-up is required to establish effectiveness and reproducibility of this novel procedure.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 91228
Program Number: ET007
Presentation Session: Emerging Technology Session (Non CME)
Presentation Type: Podium