Jessica Ardila-Gatas, MD, Matthew Allemang, MD, James Villamere, MD, Matthew Kroh, John Rodriguez, Jeffrey Ponsky. Cleveland Clinic
Introduction: Zenker's diverticulum is a false diverticulum in the upper esophagus. Symptoms include dysphagia, regurgitation of food and foul breath. Diagnosis is made with a barium swallowing exam and treatment is surgical. Open and endoscopic techniques have been described. Here we show two different modalities of flexible endoscopic treatment.
Case Presentation: Case one is an 84 year old female admitted with aspiration pneumonia and known history of Zenker’s diverticulum. Once her respiratory condition was improved she was taken to the operating room for an endoscopic cricopharyngeal myotomy using T-knife. Using the endoscope, the Zenker’s diverticulum was seen just under the esophageal opening. The scope was advanced to the stomach and a Jagwire was introduced. A nasogastric tube was passed over the wire into the stomach to serve as a guide of the esophageal lumen. Using the Triangular Tip knife the septum between the diverticulum and the esophagus was divided. Leaving just a few muscle fibers at the base and the mucosa on both sides, an endoscopic clip was applied at the apex after the myotmy was complete. The second case is a 74 year old male who had been having episodes of tightening of his throat and dysphagia with trouble swallowing. A barium swallow showed a Zenker's diverticulum. Endoscopic intervention was offered. The diverticulum was identified and proximal to it a submucosal injection was made of methylene blue and saline. Using the Triangular Tip knife, a mucosotomy was made. Mucosal flaps were raised anterior and posteriorly around the cricopharyngeal bar, and a submucosal tunnel was entered. The diverticular muscle was identified and divided. Finally, the mucosotomy was closed using endoscopic clips. Both patients underwent contrast swallow studies on postoperative day 1 that showed no leak or retention of contrast. They were both discharged home tolerating liquids.
Discussion: Different techniques for intraluminal surgery for the treatment of Zenker’s diverticulum have been described. These depend on the surgeon’s skills and patient selection. Advantage of endoscopic approach is the short recovery time, earlier advancement of diet and feasibility in high risk surgical patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 85539
Program Number: V066
Presentation Session: Thursday Exhibit Hall Theater (Non CME)
Presentation Type: EHVideo