Transoral endoluminal treatment of a Zenker's diverticulum with a laparoscopic vessel tissue sealer.

A 75-year-old woman with a previous history of Zenker’s diverticulum was admitted because of dysphagia and weight loss. A barium swallow (Fig. 1A) and upper GI endoscopy showed the esophageal lumen to be dislocated by the esophageal diverticulum (Fig. 1B). We performed a transoral septotomy using a laparoscopic vessel-tissue sealer (LigaSure, Covidien, Mass). The procedure was performed in the presence of a chest surgeon and an anesthesiologist with the patient under general anesthesia (Video 1, available online at www.VideoGIE.org). A gastroscope (Olympus GIFQ 165, Olympus Optical Co, Tokyo, Japan) was used to place an overtube diverticuloscope with a bivalve tip (Cook Medical, Limerick, Ireland) (Fig. 1C) “straddling” the diverticular septum (Fig. 1D). The LigaSure (Fig. 1E) was then placed in parallel with a small-diameter gastroscope (Olympus GIF-XP150N) for an adequate view and grasping of the esophageal septum (Figs. 1F and G). The septum was then sealed and sectioned over 3 cycles (1 cm at a time) until 5 mm of septum remained (Fig. 1H). It was elected not to place hemostatic clips. The patient’s oral intake of fluids and mashed food continued regularly until a normal diet was resumed. One month later, upper endoscopy showed a very small residue of the diverticular septum (Fig. 1I).

Figure 1

A, X-ray picture of the Zenker's diverticulum. B, Endoscopic picture of the Zenker's diverticulum. C, Diverticuloscope. D, Diverticular septum. E, Laparoscopic vessel-tissue sealer. F, LigaSure over the septum (jaws open). F, LigaSure over the septum (jaws closed). G, Diverticular septum after the section. H, Residue of the diverticular septum. I, Residue of the diverticular septum after 1 month.

Disclosure

All authors disclosed no financial relationships relevant to this publication.