Flexible endoscopic diverticulotomies for bilateral Zenker's diverticula (with videos)

Objectives/Hypothesis: Zenker's diverticulum (ZD) is the posterior pulsion diverticulum below the esophageal introitus through or above the cricopharyngeal muscle. We report a unique case of bilateral ZD that was successfully treated with an endoscopic diverticulotomies on the bilateral cricopharyngeal bars. Study Design: Case report at a tertiary referral center. Methods: A patient with bilateral ZD who failed surgery underwent two endoscopic diverticulotomies on the bilateral cricopharyngeal bars. Outcome measures were symptomatic improvement and radiological measurements. Results: After up to 18 months follow-up, the patient enjoys near complete symptomatic resolution with associated radiological improvements. Conclusions: Endotherapy can disrupt the circular muscle of the cricopharyngeal bar, decrease the depth of bar, increase the esophageal ZD diameter, and create an opening of the diverticulum allowing diverticular drainage into the esophagus.