Double incision and snare resection in symptomatic Zenker’s diverticulum: a modification of the stag beetle knife technique

Abstract

Relief from dysphagia and regurgitation are the main goals of therapy in symptomatic Zenker's diverticulum. Flexible endoscopic treatment has proved to be an effective and safe method in control of these symptoms. The aim of our study was to further improve the resection of the cricopharyngeal muscle using a new technique, the double incision and snare resection (DISR) procedure, to reduce the recurrence rate. From February 2016 to April 2017, 16 patients were treated with 18 DISR procedures at our institution. The symptoms of the patients were recorded by a seven-item questionnaire prior to treatment, and re-evaluation was scheduled at 1 and 6 months after treatment. The median age was 70 years (range 55 - 85), and 10 patients were men (62 %). The median size of the diverticulum was 20 mm (range 5 - 40 mm), and the DISR procedure was performed in 28 minutes (range 20 - 47 minutes), with no major postinterventional complications. All patients re-started oral nutrition on the day after the intervention; a gastric tube was not required. The median follow-up was 3 months (range 1 - 15 months). Two patients received a planned second-step procedure, one because of a very large cricopharyngeal muscle and one because of a cyst inside the Zenker's bridge. Although one patient suffered from mild recurrence of symptoms, she refused a second treatment. All other patients were free of symptoms after treatment. The DISR procedure is a new endoscopic treatment technique that safely and reproducibly offers relief from symptomatic Zenker's diverticulum.