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. 2017 May 7;23(17):3084-3091.
doi: 10.3748/wjg.v23.i17.3084.

New flexible endoscopic controlled stapler technique for the treatment of Zenker's diverticulum: A case series

Johanna Wilmsen  1 , Robert Baumbach  1 , Dietmar Stüker  1 , Vincens Weingart  1 , Frank Neser  1 , Stefan Karl Gölder  1 , Christof Pfundstein  1 , Ellen Claudia Nötzel  1 , Thomas Rösch  1 , Siegbert Faiss  1
Affiliations

New flexible endoscopic controlled stapler technique for the treatment of Zenker's diverticulum: A case series

Johanna Wilmsen et al. World J Gastroenterol. .

Abstract

Aim: To report about the combination and advantages of a stapler-assisted diverticulotomy performed by flexible endoscopy.

Methods: From November 2014 till December 2015 17 patients (8 female, 9 male, average age 69.8 years) with a symptomatic Zenker diverticulum (mean size 3.5 cm) were treated by inserting a new 5 mm fully rotatable surgical stapler (MicroCutter30 Xchange, Cardica Inc.) next to an ultrathin flexible endoscope through an overtube. The Patients were under conscious sedation with the head reclined in left position, the stapler placed centrally and pushed forward to the bottom of the diverticulum. The septum was divided by the staple rows under flexible endoscopic control.

Results: In eleven patients (64.7%) the stapler successfully divided the septum completely. Mean procedure time was 21 min, medium size of the septum was 2.8 cm (range 1.5 cm to 4 cm). In four patients the septum was shorter than 3 cm, in seven longer than 3 cm. To divide the septum, averagely 1.3 stapler cartridges were used. Two minor bleedings occurred. Major adverse events like perforation or secondary haemorrhage did not occur. After an average time of two days patients were discharged from the hospital. In 6 patients (35.3%) the stapler failed due to a thick septum or insufficient reclination of the head. Follow up endoscopy was performed after an average of two months in 9 patients; 4 patients (44.4%) were free of symptoms, 5 patients (55.6%) stated an improvement. A relapse of symptoms did not occur.

Conclusion: Flexible endoscopic Zenker diverticulotomy by using a surgical stapler is a new, safe and efficient treatment modality. A simultaneously tissue opening and occlusion prevents major complications.

Keywords: Flexible endoscopic treatment; Overtube; Stapler technique; Surgical stapler; Zenker’s diverticulum.

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Conflict of interest statement

Conflict-of-interest statement: To the best of our knowledge, no conflict of interest exists. The authors alone are responsible for the content and writing of the paper.

Figures

Figure 1
Figure 1
5 mm surgical stapler articulating to 80 degrees (MicroCutter30 Xchange, Cardica Inc., Redwood City, CA, United States/Cardica GmbH, Laichingen, Germany) is shown.
Figure 2
Figure 2
ZD overtube, Cook Endoscopy, Winston-Salem, NC, United States.
Figure 3
Figure 3
Septum is shown between the diverticulum and the esophagus stressed by the overtube (Zenker’s diverticulum over- tube, Cook Endoscopy, Winston-Salem, NC, United States).
Figure 4
Figure 4
Centrally placed stapler is shown under flexible endoscopic control.
Figure 5
Figure 5
Complete dissection of the septum is shown up to the bottom of the diverticulum with visible stapler stitches.
Figure 6
Figure 6
Flow chart of of flexible endoscopic stapler Zenker diverticulotomy.
See this image and copyright information in PMC

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