Endostitch-assisted endoscopic Zenker's diverticulostomy: a tried approach for difficult cases

The aim was to describe a tried approach to endoscopic Zenker's diverticulostomy, especially in those patients with unfavorable anatomy or smaller pouches who may otherwise be relegated to open repair. The study design was a retrospective case series The setting was an urban, tertiary care university medical center There were seven patients, both inpatient and outpatient, with chief complaints of dysphagia. All had a documented Zenker's diverticulum (ZD) on barium swallow. All of the patients were deemed by the primary surgeon to have some anatomic factor that limited exposure of the diverticulum. The patients underwent Endostitch-assisted endoscopic Zenker's diverticulostomy. Records were retrospectively reviewed, including preoperative and postoperative swallowing status, radiographic findings, operative findings, and follow-up results. Seven patients were reviewed, each of whom had successful endoscopic treatment of ZD. Notably, in each case, an anatomical factor precluded the seating of the gastrointestinal anastomosis (GIA) stapler on the cricopharyngeal bar without the use of endoscopic retention sutures. The majority of the patients were discharged on postoperative day one. All but one patient noted a marked improvement in swallowing function immediately following the procedure and at their outpatient follow-up visit. Endoscopic Zenker's diverticulostomy has been well-described and established as a reliable technique in a majority of cases. We report on our experience using a previously described technique specifically for difficult, unfavorable, or contraindicated cases and suggest the employment of this technique as an alternative method to facilitate endoscopic repair and possibly limit the need for an open approach.