Monday Poster Session
Category: Endoscopy Video Forum
Ahmad Najdat Bazarbashi, MD
Assistant Professor of Medicine
Washington University in St. Louis/Barnes Jewish Hospital
St. Louis, MO
A 65 year old man with a history of ZD previously treated with transoral staple myotomy and subsequent revisional transcervical cricopharyngeal myotomy with diverticular imbrication for recurrence presented to our clinic with dysphagia, regurgitation and weight loss. A Barium esophagogram confirmed recurrent ZD. Decision was made to proceed with flexible endoscopic zenker septotomy (Video 1). Endoscopy demonstrated a large ZD with impacted food and staples from previous surgery. Orogastric (OG) tube placement was unsuccessful due to narrow esophageal lumen; a 0.035” guidewire was then placed, and a 14 French OG tube was placed over the wire. With the OG tube in place, the septum was dissected using a scissor-type electrocautery knife (Endo Cut, Effect 1, Duration 1, Interval 1). Significant scarring was noted from prior surgery. During dissection, a staple was dislodged and retrieved using rat-tooth forceps. Three hemostatic clips were placed to reduce risk of post-operative bleeding and leak. The OG tube was removed and at the end of the procedure luminal diameter was significantly increased. Esophagram one day post-procedure showed improved contrast flow past the diverticulum without evidence of leak. At one month follow-up, he reported normal swallowing and ability to tolerate of regular diet.