Dados do Trabalho

Título

The first endoscopic diverticulectomy for a Zenker’s Esophageal Diverticula in Iran

Apresentação do Caso

A 95-years-old woman presenting with a chronic history of frequent cough, dysphagia for solids and later difficulty in swallowing fluids along with decreased appetite and weight loss from 6 months ago. The primary diagnosis was food impaction and the upper gastrointestinal endoscopy was performed for several times and the oesophageal lumen was not visible and couple of endoscopists reported esophagus as blind loop full of food remnant.
We supposed these reposts compatible with diverticula. So a barium swallow requested, but the patient was so disabled and unable to do it. So at first the food remnant exsect by a basket, then after several attempts, the entrance of esophagus found beside large inlet of diverticula. According to the patient’s age and general condition, the surgeon consultation considered her as inoperable and offered a surgical gastrostomy. So a endoscopic diverticulectomy was considered as a therapeutic option for the management. Endoscopic Zenker diverticulotomy was done using flexible endoscope under deep sedation. At first a guide wire passed into the stomach, then a NG tube passed to keep the lumen of esophagus open, then the cricopharyngeal muscle and septate between diverticula and esophagus cut with knife and 4 hemoclips deployed in the site of diverticulectomy and hemostasis achieved. Both the procedure and the postoperative course were free of complications. The patient kept NPO for 72 h then she permitted to swallow water and the day after, she start to eat. 5 days after procedure, she discharged with improvement of general condition

Discussão

Traditionally surgical resection has been the optimal treatment of esophageal (Zenker) diverticula over the past century. Developments in minimally invasive surgery and new endoscopic devices have led to a paradigm change.

Comentários finais

Nowadays, Zenker’s Diverticulum can be treated by flexible endoscopy as a quick and safe technique

Palavras-Chave

Zenker's Diverticulum, endoscopy, diverticulectomy