Flexible endoscopic clip-assisted Zenker's diverticulotomy (with videos)

BackgroundIn treating Zenker's diverticulum (ZD), there are potential risks associated with flexible endoscopic diverticulotomy without suturing or stapling. Rigid endoscopic stapler-assisted diverticulotomy has limitations. The septum is usually not completely dissected with either technique.ObjectiveOur purpose was to evaluate the feasibility of flexible endoscopic clip-assisted diverticulotomy (ECD) for complete septum dissection.DesignCase report.SettingAcademic center.PatientAn elderly male with symptomatic residual ZD.InterventionsAfter 1 endoclip (InScope multiclip applier, Ethicon Endo-Surgery) was placed on each side of the cricopharyngeal bar, the septum was easily and completely dissected between these 2 clips down to the bottom of the diverticulum into the esophageal mucosa with a needle-knife.Main Outcome MeasurementSymptom resolution and complications.ResultsComplete esophageal symptom resolution without complications.LimitationCase report.ConclusionsECD is feasible, easy, safe, and effective for complete septum dissection. This is the first reported case of ECD. ECD provides another option in managing ZD with flexible endoscopy.