Preliminary report of a new scissor-like device for endoscopic submucosal dissection (ESD) for safe and effective treatment of Zenker's diverticulum

Introduction: Endoscopic therapy of Zenker's diverticulum is based on cutting the septum between the diverticulum and the esophageal lumen by using lasers, staplers, harmonic scalpels, argon plasma coagulation, or needle knives. Most recently, a new scissor-like device with serrated jaws for endoscopic submucosal dissection (ESD) was introduced. The device is fully rotatable and available in different lengths. In addition, the outer edges are insulated to minimize the risk of damaging tissue.

Aims: First study to prospectively assess the potential of the new scissor-like ESD device for treatment of Zenker's diverticulum.

Material and methods: Patients with Zenker's diverticulum were prospectively enrolled. With the patient under conscious sedation a conventional feeding tube was first placed through the nose of the patient. A single channel endoscope with a clear distal cap was used for all examinations. The scissor like device allows for selective grasping and cutting of the septum and the muscle fibers. Performance characteristics, complications and follow-up data were recorded.

Results: So far, five patients were treated (mean age 74 years, Range 65 – 80 years; 3 female). Mean diameter of Zenker's diverticulum was 32 mm (Range 20 – 50 mm). Mean procedure time was 4.8 minutes (Range 3 – 7 minutes). No bleeding was recorded. In one case opening of the deep muscle layer occurred which was closed with 3 hemoclips. Postprocedural course was uneventful in all cases. All patients described significant symptom improvement without any relapsing symptoms (mean follow up time 6 months).

Conclusion: Endoscopic treatment of Zenker's diverticulum with the new scissor-like ESD device is fast and efficient. These preliminary findings should now be evaluated in future prospective, controlled multicenter trials.