3088 Zenker's Full Thickness Diverticulotomy Combined With Botox Injection

Abstract

INTRODUCTION: We present a case of an 88 year old gentleman with a history of dysphagia and a recent episode of aspiration pneumonia. A routine swallow evaluation showed a defect in the cricopharyngeal region. A follow up esophagram revealed a large Zenker's diverticulum. We present a case of full thickness endoscopic Zenkers diverticulotom followed by Botox injection post diverticulotomy and resolution of symptoms on one month follow up. CASE DESCRIPTION/METHODS: The endoscope was introduced into the esophagus, a wire was passed, then a nasogastric tube was passed into the stomach via the wire, this was used to identify the esophageal lumen. Using a hybrid I knife The diverticulotomy was started. Complete dissection and myotomy of the diverticulum was completed. 10 cc of 100 units of botox were then injected to the proximal esophageal muscle and a diverticular ricopharyngeal muscle. In order to assess for perforation, a upper esophagram was preformed that showed no evidence of leak and the patient was discharged. 30 day follow up showed a completely resolved Zenkers diverticulum and an asymptomatic patient from dysphagia and no evidence of recurrent aspiration pneumonia. DISCUSSION: Zenker's diverticulum can be repaired with a variety of surgical and procedural options. However, endoscopic intervention has been shown to reduce operative time and to simplify management in postoperative care. We introduce a novel approach using Botox injections following Zenker's full thickness diverticulotomy to correct a diverticular pouch and relax the surrounding musculature. The video case report showcases the practicality and effectiveness of the procedure. Watch the video: http://bit.ly/2M2fgMv