title: Endoscopic flexible treatment of Zenker's diverticulum: a modification of the needle-knife technique.
abstract: OBJECTIVE
  Endoscopic treatment of Zenker's diverticulum has been successfully reported over the last 10 years using different approaches. The hook-knife is a new device originally developed for endoscopic submucosal dissection procedures. This study aimed to investigate the safety and efficacy of endoscopic myotomy performed with the hook-knife.
  
  
  METHODS
  From July 2005, 32 consecutive patients (23-male, mean age 74.8 years) with dysphagia secondary to the presence of Zenker's diverticulum were prospectively enrolled. Myotomy was performed using a straight-end transparent hood to the tip of the scope and the hook-knife for the incision of the bridge between the Zenker's diverticulum and the esophagus. Clinical outcome was evaluated assigning a dysphagia symptom score from 0 (symptoms absent) to 4 (inability to swallow saliva).
  
  
  RESULTS
  General anesthesia was used in 4 patients, deep sedation with propofol in 23 patients, while midazolam was used in 5 patients. The mean procedural time was 28 minutes. Complications occurred in 2 patients (6.25 %). At 1 month follow-up, the mean dysphagia score was significantly improved from 2.9 to 0.6 ( P < 0.001) with 87.5 % of patients free of symptoms and 4 patients with dysphagia that was persistent but milder than before the treatment. Three of these 4 patients underwent a successful second endoscopic treatment with complete relief of dysphagia; one was not re-treated because of advanced age (92 years). During the follow-up period (23.87 +/- 9.6 months), 2 patients developed dysphagia recurrence. The overall success rate was 90.6 %.
  
  
  CONCLUSIONS
  Diverticulectomy with a flexible scope and the hook-knife may represent a safe and effective alternative treatment for patients with Zenker's diverticulum.
authors.affiliation: Department of Gastroenterology, Digestive Endoscopy Unit, IRCCS Istituto Clinico Humanitas, Milano, Italy. alessandro.repici@humanitas.it
authors.forename: A
authors.initials: A
authors.lastname: Repici
authors.forename: N
authors.initials: N
authors.lastname: Pagano
authors.forename: F
authors.initials: F
authors.lastname: Romeo
authors.forename: S
authors.initials: S
authors.lastname: Danese
authors.forename: M
authors.initials: M
authors.lastname: Arosio
authors.forename: G
authors.initials: G
authors.lastname: Rando
authors.forename: G
authors.initials: G
authors.lastname: Strangio
authors.forename: A
authors.initials: A
authors.lastname: Carlino
authors.forename: A
authors.initials: A
authors.lastname: Malesci
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D016672:Zenker Diverticulum / Q000150:complications / Q000628:therapy*