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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
New flexible endoscopic controlled stapler technique for the treatment of Zenker's diverticulum: A case series
Johanna Wilmsen, Robert Baumbach, Dietmar Stüker, Vincens Weingart, Frank Neser, Stefan Karl Gölder, Christof Pfundstein, Ellen Claudia Nötzel, Thomas Rösch, Siegbert Faiss
Johanna Wilmsen, Robert Baumbach, Siegbert Faiss, Department of Gastroenterology and Interventional Endoscopy, Asklepios Hospital Barmbek, Semmelweis University, Medical Faculty, Campus Hamburg, 22291 Hamburg, Germany
Dietmar Stüker, Department of Interdisciplinary Endoscopy, University Medical Center Tübingen, 72076 Tübingen, Germany
Vincens Weingart, Department of Internal Medicine, Garmisch-Partenkirchen Medical Center, 82467 Garmisch-Partenkirchen, Germany
Frank Neser, Department of Internal Medicine II, Hospital Chemnitz, 09116 Chemnitz, Germany
Stefan Karl Gölder, Department of Internal Medicine III, Zentralklinikum Augsburg, 86156 Augsburg, Germany
Christof Pfundstein, Private Practice for Internal Medicine and Gastroenterology, 81675 Munich, Germany
Ellen Claudia Nötzel, Department of Internal Medicine and Gastroenterology, Sana Hospital Lichtenberg, 10365 Berlin, Germany
Thomas Rösch, Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
Author contributions: Baumbach R, Stüker D, Weingart V, Neser F, Gölder SK, Pfundstein C, Nötzel EC, Rösch T and Faiss S performed the diverticulotomy and collected data; Wilmsen J carried out acquisition, analysis and interpretation of data, and wrote the manuscript; all authors reviewed the manuscript and approved the final version.
Institutional review board statement: Ethical approval was not required, since the stapler diverticulotomy is an individual expanded access.
Informed consent statement: The diverticulotomy was performed after patients were informed about possible complications, alternative treatment options and they had given their informed consent.
Conflict-of-interest statement: To the best of our knowledge, no conflict of interest exists. The authors alone are responsible for the content and writing of the paper.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Johanna Wilmsen, Department of Gastroenterology and Interventional Endoscopy, Asklepios Hospital Barmbek, Semmelweis University, Medical Faculty, Campus Hamburg, Rübenkamp 220, 22291 Hamburg, Germany. j.wilmsen@asklepios.com
Telephone: +49-40-1818828499 Fax: +49-40-1818823809
Received: December 27, 2016
Peer-review started: December 28, 2016
First decision: January 19, 2017
Revised: February 20, 2017
Accepted: March 21, 2017
Article in press: March 21, 2017
Published online: May 7, 2017
Processing time: 130 Days and 0.7 Hours
AIM
To report about the combination and advantages of a stapler-assisted diverticulotomy performed by flexible endoscopy.
METHODS
From November 2014 till December 2015 17 patients (8 female, 9 male, average age 69.8 years) with a symptomatic Zenker diverticulum (mean size 3.5 cm) were treated by inserting a new 5 mm fully rotatable surgical stapler (MicroCutter30 Xchange, Cardica Inc.) next to an ultrathin flexible endoscope through an overtube. The Patients were under conscious sedation with the head reclined in left position, the stapler placed centrally and pushed forward to the bottom of the diverticulum. The septum was divided by the staple rows under flexible endoscopic control.
RESULTS
In eleven patients (64.7%) the stapler successfully divided the septum completely. Mean procedure time was 21 min, medium size of the septum was 2.8 cm (range 1.5 cm to 4 cm). In four patients the septum was shorter than 3 cm, in seven longer than 3 cm. To divide the septum, averagely 1.3 stapler cartridges were used. Two minor bleedings occurred. Major adverse events like perforation or secondary haemorrhage did not occur. After an average time of two days patients were discharged from the hospital. In 6 patients (35.3%) the stapler failed due to a thick septum or insufficient reclination of the head. Follow up endoscopy was performed after an average of two months in 9 patients; 4 patients (44.4%) were free of symptoms, 5 patients (55.6%) stated an improvement. A relapse of symptoms did not occur.
CONCLUSION
Flexible endoscopic Zenker diverticulotomy by using a surgical stapler is a new, safe and efficient treatment modality. A simultaneously tissue opening and occlusion prevents major complications.
Core tip: The new flexible MicroCutter30 XChange can dissect the septum of a Zenker diverticulum (ZD) under flexible endoscopic vision control. The simultaneous division and closure of the cutting edge by the staple rows prevents major bleedings or perforations. The combination of a flexible endoscopy and a surgical stapler is a significant advantage in the treatment of ZD.
