title: Interest of submucosal dissection knife for endoscopic treatment of Zenker's diverticulum.
abstract: BACKGROUND
  Dual-Knife(®) (Olympus) and Hydride-Knife(®) are new needle knives frequently used for submucosal dissection because of their safety and precision. In this study we aimed to evaluate the efficacy and safety of such devices in the diverticulopexy by flexible endoscopy.
  
  
  METHODS
  From February 2009 to March 2013, 42 patients (25 men), mean age 74.5, with symptomatic Zenker's diverticulum, were included in a non-randomized prospective multicenter study. The symptoms described by all patients include dysphagia, regurgitation and/or swallowing disorders. The diverticulopexy was performed with the Dual-Knife(®) or Hydrid-Knife(®), after septum exposure with the diverticuloscope, and terminated with distal tip clips positioning. All complications were noted. Patients' symptoms were regularly assessed during follow-up visits or telephone interviews.
  
  
  RESULTS
  The first endoscopy treatment was successful for all patients. Thirty-seven patients (88%) had symptoms improvement after the first treatment. The recurrence rate was 14% (6 patients); a second endoscopic treatment was required 12 months on average after the first treatment, with 100% efficiency. Mid-term (16 months) efficiency was 91.67% after 1 to 3 endoscopic treatments. A total of 55 procedures were performed without perforation or significant bleeding and 3 patients underwent surgery. In multivariate analysis, the diverticulum size and the type of dissection knife were not risks factors for recurrence.
  
  
  CONCLUSIONS
  Endoscopic diverticuloscope-assisted diverticulotomy with submucosal dissection knives is a safe and effective alternative treatment for patients with a symptomatic Zenker's diverticulum measuring between 2 and 10 cm.
authors.affiliation: Hepato-Gastro-Enterology Department, Hôpital Saint Joseph, 26 bd de Louvain, 13008, Marseille, France, alaquiere@hopital-saint-joseph.fr.
authors.forename: A
authors.initials: A
authors.lastname: Laquière
authors.forename: P
authors.initials: P
authors.lastname: Grandval
authors.forename: J P
authors.initials: JP
authors.lastname: Arpurt
authors.forename: J
authors.initials: J
authors.lastname: Boulant
authors.forename: S
authors.initials: S
authors.lastname: Belon
authors.forename: S
authors.initials: S
authors.lastname: Aboukheir
authors.forename: R
authors.initials: R
authors.lastname: Laugier
authors.forename: G
authors.initials: G
authors.lastname: Penaranda
authors.forename: L
authors.initials: L
authors.lastname: Curel
authors.forename: C
authors.initials: C
authors.lastname: Boustière
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection / Q000295:instrumentation* / Q000379:methods; D004945:Esophagoscopy / Q000295:instrumentation* / Q000379:methods; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000601:surgery; D011446:Prospective Studies; D016896:Treatment Outcome; D016672:Zenker Diverticulum / Q000601:surgery*