Endoscopic dissection of Zenker's diveriticulum using a Holmium laser.

Introduction: Zenker's diverticulum is a rare disease which leads to dysphagia, regurgitation, difficulty in swallowing and sometimes aspiration. The annual incidence is 2 out of 10.000 inhabitants. Endoscopic treatment of Zenker's diverticulum has been done since 1995 and is widely used at present. Different techniques using argonplasmacoagulation, needle knife or ESD- knives have been described. The aim of our study was to determine the efficacy and safety of endoscopic diverticulotomy using a holmium laser. Methods: From February 2013 to February 2016 patients with symptomatic Zenker's diverticulum were collected prospectively. Dissection of the septum between esophagus and diverticulum and myotomy was performed under conscious sedation using a holmium laser via a standard gastroscope. Results: 15 patients with symptomatic Zenker's diverticulum were treated. The median length of the septum was 2,9 cm. 3 patients required a second attempt until normalization of dysphagia was achieved. All procedures were performed without any bleeding or perforation. Conclusion: Endoscopic diverticulotomy using a holmium laser is safe and effective. The main advantages of this technique are completeness of myotomy due to good visualization of the fibers of the cricopharyngeal muscle and the absence of bleeding.