Flexible Zenker's Per-oral Endoscopic Myotomy

Abstract

Zenker's diverticulum is a pulsion-type pseudodiverticulum of the pharyngoesophageal segment. Endoscopic surgery is primarily directed at dividing the common wall between the esophagus and diverticulum. Rigid exposure with diverticuloscopes have allowed for common wall division with staplers, lasers, and advanced energy sealers, however not all patients can be successfully treated with rigid instrumentation. As a result, flexible endoscopic surgery provides another option for patients. This technique employs various instrumentation through the working channel of a gastroscope to not only divide the common wall but seal the incision, which if done appropriately, results in a symptom resolution with complication rates comparable to rigid techniques. Flexible endoscopic surgery requires the surgeon to perform technically challenging submucosal dissection through a gastroscope as well as possess expertise with advanced energy delivery systems and instrumentation. However, with time, surgeons can build these skills to offer the breadth of surgical options tailored to the individual patient.