VideoGIE| Volume 84, ISSUE 6, P1050-1051, December 2016

Endoscopic treatment of Zenker's diverticulum: a simplified needle-knife technique

      Flexible endoscopic diverticulostomy (septotomy) with the assistance of a guidewire, a nasogastric tube, a plastic overtube, or a diverticuloscope seems to be a safe and effective treatment of symptomatic Zenker’s diverticulum (ZD) in the esophagus. The purpose of the assistance is to make the operative field clearer. However, those assisted devices can cause trauma in the diverticulum and unnecessarily increase operation time. This video demonstrates that a simplified needle-knife technique can be easily and safely performed without the aforementioned assistance devices. A 62-year-old man with ZD underwent endoscopic septotomy for dysphagia and weight loss. To protect the airway, he was intubated. A ZD was found in the proximal esophagus, 17 cm from the entry site (Fig. 1A). Using a high-resolution Olympus gastroscope and a standard mucosectomy cap on the tip of the gastroscope, we easily dissected with a needle-knife, which is sharp and thin, about 3 cm of the septum in the middle with the esophageal lumen placed anteriorly (Fig. 1B-D; Video 1, available online at About 15% of the septum was left intact to prevent perforation. The patient had no adverse events and was discharged after a 24-hour observation period. He remains asymptomatic after 6 months of follow-up.
      Figure thumbnail gr1
      Figure 1Endoscopic treatment steps. A, Zenker's diverticulum under endoscopic view. B, C, Septotomy with a needle-knife. D, Endoscopic view after septotomy.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect