Endoscopic treatment of Zenker’s diverticulum with the stag beetle knife (sb knife) – feasibility and follow-up

Goelder, SK; Brueckner, Juliane; Messmann, Helmut

doi:10.1080/00365521.2016.1186729

Cited by 39 publications

(23 citation statements)

References 10 publications

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“…In a retrospective study of 31 patients undergoing SB knife septal myotomy, 44 Battaglia et al described a median procedure time of only 14 min, with 83.9% of patients in symptom remission after a median follow up of 7 months. Efficacy and safety data were replicated by Goelder et al 59 (N = 52), who reported a low recurrence rate of 9.6% over 6 months, without complications of perforation or mediastinitis.…”

Section: Evolution Of Devicesmentioning

confidence: 83%

New and emerging techniques for endoscopic treatment of Zenker's diverticulum: State‐of‐the‐art review

Ishaq

Sultan

Siau

et al. 2018

Digestive Endoscopy

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Zenker's diverticulum (ZD), or pharyngeal pouch, is an anatomical defect characterized by herniation of the posterior pharyngeal wall through Killian's dehiscence, and may result in dysphagia and regurgitation. Multiple therapeutic modalities including surgery, rigid and flexible endoscopy have been developed to manage ZD. Although surgical management with open and endoscopically assisted techniques have historically been the mainstay of ZD treatment, minimally invasive flexible endoscopic techniques, carried out under conscious sedation, are increasingly favored. Over the last two decades, the advent of new accessories and techniques have changed the landscape of endotherapy for ZD, with the current armamentarium including, but not limited to, endoscopic stapling, CO laser, argon plasma coagulation, needle knife, bipolar forceps, hook knife, clutch cutter, stag beetle knife, and submucosal tunneling endoscopic septum division. We hereby review the latest evidence to support the endoscopic management of ZD.

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Section: Evolution Of Devicesmentioning

confidence: 83%

New and emerging techniques for endoscopic treatment of Zenker's diverticulum: State‐of‐the‐art review

Ishaq

Sultan

Siau

et al. 2018

Digestive Endoscopy

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“…Repici et al[29] for example required an average of 60 min for a flexible myotomy, Goelder et al[30] 32 min.…”

Section: Discussionmentioning

confidence: 99%

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

Wilmsen

Baumbach

Stüker

et al. 2017

WJG

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AIMTo report about the combination and advantages of a stapler-assisted diverticulotomy performed by flexible endoscopy.METHODSFrom 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.RESULTSIn 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.CONCLUSIONFlexible 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.

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“…Demographic data, medical history and specifically prior treatments for ZD, anticoagulant or antiplatelet medication, clinical symptoms, and general health status were recorded. Symptoms were graded using the Augsburg symptom score dedicated to the ZD [10] and comorbid conditions with the Charlson Index [11]. Malnutrition was defined by a body mass index < 18.5 Kg/m² [12].…”

Section: Methodsmentioning

confidence: 99%

Endoscopic treatment of Zenkerʼs diverticulum by complete septotomy: initial experience in 19 patients

et al. 2020

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Background and study aims Endoscopic treatment of Zenker’s Diverticulum (ZD) using a flexible endoscope and a diverticuloscope consists of myotomy of the cricopharyngeus muscle, sparing the lower part of the diverticular septum. However, recurrence occurs in up to 54 % of patients at 4 years. We assessed the feasibility and safety of a complete septotomy in endoscopic treatment of ZD. Patients and methods We conducted a retrospective analysis of a prospectively collected database at a single referral center. All consecutive patients treated by complete resection of the diverticular wall were included. The endoscopic technique used a distal attachment cap and division of the ZD septum using a Dual Knife or a Triangle Tip knife in endocut mode, until the esophageal muscularis propria was seen and no residual diverticulum remained. Symptoms were evaluated using the Augsburger questionnaire. Results Nineteen patients, 10 of whom were men with mean age 79 ± 12 years, were treated by complete septotomy for a symptomatic ZD with a median size of 2.5 cm (range 1–5 cm). The clinical success rate was 100 % and the complication rate was 10 % (one pneumonia and one atrial fibrillation). Median hospital stay was 2 days (range 1–3 days). On Day 1 esophagogram, no extraesophageal contrast leakage was seen, periesophageal CO2 was still visible in two patients, and complete ZD regression was seen in 63 % of patients. The 6-month clinical success rate was 100 %, with two patients lost to follow-up, and a median symptom score of 0 (range 0–4). After a mean ± SD follow-up of 9 ± 5 months, the clinical success rate was 94 % (16/17). Conclusion Complete endoscopic septotomy is a feasible and safe therapeutic modality in patients with symptomatic ZD that does not require use of a diverticuloscope, and with good short-term efficacy. The complete regression of the diverticulum observed on Day 1 in 63 % of patients could be a marker of long-term clinical success.

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Endoscopic treatment of Zenker’s diverticulum with the stag beetle knife (sb knife) – feasibility and follow-up

Abstract: Flexible endoscopic treatment of ZD with the sb knife and overtube is effective, safe, and has lasting effects with a relatively low recurrence rate.

Cited by 39 publications

References 10 publications

New and emerging techniques for endoscopic treatment of Zenker's diverticulum: State‐of‐the‐art review

New and emerging techniques for endoscopic treatment of Zenker's diverticulum: State‐of‐the‐art review

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

Endoscopic treatment of Zenkerʼs diverticulum by complete septotomy: initial experience in 19 patients

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