Endoscopic treatment of Zenker's diverticulum with an oblique-end hood attached to the endoscope

Background: The feasibility and efficacy of incision of the septum between the pharyngoesophageal (Zenker's) diverticulum and the esophagus with a flexible endoscope and needle-knife have been demonstrated. Exposure of the septum remains a critical element of the procedure. This is a report of a technical improvement in this technique: use of a transparent oblique-end hood attached to the tip of the endoscope. Methods: Ten patients (10 men, age range 67-87 years) with Zenker's diverticulum were treated. With the aid of an oblique-end hood attached to the tip of the endoscope, the septum between the Zenker's diverticulum and esophagus was incised with pure coagulation current. A 10F nasogastric tube was left in place for 48 hours after the procedure to provide nutrition. Thereafter, oral intake was progressively resumed. Results: Complete incision of the septum was achieved in a single session in all cases. Bleeding or perforation did not occur in this small series. Complete relief of dysphagia was reported by all patients during follow-up that ranged from 2 to 12 months. Conclusions: With the use of the oblique-end hood attached to the tip of the endoscope, incision of Zenker's diverticulum is simplified and can be performed as a single-session procedure.