A new device to simplify flexible endoscopic treatment of Zenker's diverticulum.
BACKGROUND
Endoscopic treatment of a Zenker's diverticulum (ZD) is challenged by maintaining a stable position and visual field. An oblique transparent cap and an overtube have been used with success. The porcine hypopharyngeal pouch is similar to a ZD. While using the widespread EMR device (WEMR) in the esophagus, we realized that the design may be advantageous for treatment of a ZD.


OBJECTIVE
To use the WEMR cap device to incise the porcine hypopharyngeal pouch septum.


METHODS
WEMR cap incision of the porcine hypopharyngeal pouch septum.


METHODS
Animal laboratory.


METHODS
Six female domestic pigs underwent endoscopy with the prototype WEMR cap. The cutting wire incised the hypopharyngeal-esophageal septum. Three pigs were immediately euthanized and underwent neck dissection. Three pigs were keep alive for 3 weeks and then underwent excisional neck dissection.


RESULTS
The procedure was technically easy. The average time was 10 minutes. Limited bleeding occurred by using cutting current and was eliminated by blended current. The entire septum could be incised with the cap edges working as a stopper, until the septum almost completely disappeared. No overt complications occurred. A follow-up endoscopy showed a small residual septum and scar. A barium swallow revealed no pouch, with ready passage into the esophageal lumen.


CONCLUSIONS
The WEMR wire-cutting cap can incise the hypopharyngeal septum in an animal model simulating ZD. This device has the advantage of providing a stable position throughout the procedure and a protective rim that controls the incision. The device facilitates this procedure.
D000818:Animals; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004867:Equipment Design; D005260:Female; D013552:Swine; D016672:Zenker Diverticulum / Q000601:surgery*