Endoscopic treatment of Zenker's diverticulum with flexible endoscope. The first Hungarian case

Introduction: Zenker's diverticulum is located proximal to the upper esophageal sphincter, usually on the posterior wall, and results in increased hypopharyngeal pressure. Symptoms include dysphagia, regurgitation and cough, and, at the very end it can leads to weightloss and/or aspiration. The standard treatment is myotomy of the cricopharyngealmuscleextended to the tissue bridge between the esophagus and the diverticulum. It can be performed by open surgery or an internal endosurgical approach by using a rigid diverticuloscope. Patient: A 69-ys old male was referred due to long lasting dysphagia and regurgitation. Barium swallow revealed a 3 × 5 cm Zenker's. Method: We performed endoscopic myotomy using flexible diverticuloscope that allows excellent septum exposure and endoscope stability. The procedure was performed under general anesthesia with orotracheal intubation with patient in the left lateral position. The patient received antibiotic prophylaxis. For cutting we used needle knife. At the bottom of the cutting we put 3 clips to avoid bleeding and perforation. Result: Next day the barium swallow showed prompt emptying of the contrast from the diverticulum to the esophagus. The patient was allowed to eat soft food. All symptoms ceased after procedure, and he remained symptomfree at 1 month, as well.Conclusion: A similar case that was performed during ESGE live show inspired us to introduce this kind of procedure into our portfolio.