Aims Flexible endoscopic treatment of symptomatic Zenker´s diverticulum (ZD) is an established
treatment option. We report our experience with a scissor-shaped, rotating device
with two insulated monopolar blades (SB knife) designed primarily for endoscopic submucosal
dissection. Little data are reported about its use for Zenker diverticulum.
Methods From Febuary 2014 to April 2019, n = 20 patients were treated at ASST-Rhodense with
the SB knife junior. The insulated blades allowed to avoid the overtube. The procedures
were performed with a cap to better evaluate the diverticulum and the septum. All
patients underwent an esophagram pre- and post-procedure, to assess esophageal transit
and perforation. Symptoms (dysphagia, regurgitation, respiratory symptoms) were analyzed
before and at the follow up using a validated scale. Procedure duration, rate of complications,
symptom changes after the procedure and rate of relapsing patients during follow up
were also recorded.
Results The procedure was carried out successfully in all patients (ZD mean size: 3 cm (1–6 cm)).
18/20 (90%) patients received one treatment session. The mean procedure time was 28 min
(18–60 min). Two patients (10%) required a second treatment after a mean of 14 months
(2–26) due to symptomatic recurrence; both patients were at the very beginning of
our experience. Two minor intraprocedural bleedings were easily treated by the ‘coagrasper’
use of the device. No major bleeding or late-onset bleeding developed. One minor perforation
occurred and was successfully treated with medical therapy.
During a mean follow-up of 27 months (1–60), a significant symptom improvement was
achieved in all the scores (dysphagia; regurgitation; respiratory symptoms).
Conclusions Flexible endoscopic treatment of ZD with the SB knife is safe, effective, and has
lasting effects on symptoms also at long term follow up, with a relatively low recurrence
rate.
