Endoscopic treatment of a Zenker's diverticulum using argon plasma coagulation

Zenker's diverticulum is a pouch that develop in the pharynx just above the upper esophageal sphincter causing swallowing problems. Dysphagia, bad breth, coughing, regurgitation, halitosis, aspiration and pneumonia, can be occur by trapped food. Many patients are elderly and can not undergo a hazardous operation. Beside a number of traditional surgical options newly developed endoscopic therapeutic methods are available for treatening the abnormality. In patients at poor health condition minimally invasive technics and new endoscopic methods are available to improve or treat the illness.

In this case we present a successful treatment of the Zenker's diverticulum using the argon plasma coagulation in a 74-years female patient. Performing standard upper gastroscopy we inroduced a thick nasogastric tube over the guide wire to keep the tissue bridge between the esophagus and diverticulum in the pronounced position. Swallowing liquid local anaesthetic before the procedure can reduce the patient sensitivity. In the same way we coagulated the septal bridge step-by-step carefully by the argon plasma beamer. Using the technique in four sessions with the interval of few weeks we achieved an adequate deep cutting near the diverticulum base. The treatment was successful and we didn't record any serious complication except of transient submucosal gas inflation in one occasion.