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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 www.giejournal.org). 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 1Endoscopic treatment steps. A, Zenker's diverticulum under endoscopic view. B, C, Septotomy with a needle-knife. D, Endoscopic view after septotomy.
