, Volume 15, Issue 2, pp 122–126 | Cite as

Cricopharyngeal myotomy with flexible endoscope for Zenker’s diverticulum using hook knife and endoclips (with video describing an objective measurement of the cutting length)

  • Francesco Pugliese
  • Lorenzo Dioscoridi
  • Antonello Forgione
  • Edoardo Forti
  • Marcello Cintolo
  • Massimiliano Mutignani
How I Do It


Cricopharyngeal myotomy with flexible endoscope is a well-known and safe treatment for Zenker’s diverticulum. We describe hereafter how we perform this flexible endotherapy. From January 2011 to January 2017, we treated 28 patients with this endotherapy. Our technique is described step-by-step in the paper: the main principle is to perform an endoscopic cut of the diverticular septum and cricopharyngeal muscle’s fibers (see the video). We describe an objective measurement of the cutting length and depth of the myotomy. Technical success was achieved in all the patients. As to clinical success, 76.2% of patients showed a significant improvement and relevant disappearance of preoperative dysphagia. The present follow-up ranges from 6 months to 5 years. This flexible endoscopic technique can overcome some limitations of rigid endoscopic technique (i.e., upper teeth protrusion, inadequate jaw opening, or limited neck mobility). The main indication was based on clinical presentation and referred to the diverticular dimensions between 2 and 5 cm. Tips for the technique are described in the paper. This variant of cricopharyngeal myotomy with flexible endoscopy is feasible and effective for the treatment of Zenker’s diverticulum in selected patients.


Zenker’s diverticulum Cricopharyngeal myotomy Endotherapy 


Compliance with ethical standards

Ethical Statement

The present study conforms to the guidelines set forth in the Helsinki Declaration of 1975, as revised in 2000, concerning Human and Animal Rights, and the doctors declare that they followed the policy concerning Informed Consent.

Conflict of interest

Dr F. Pugliese, Dr L. Dioscoridi, Dr A. Forgione, Dr E. Forti, Dr M. Cintolo, and Dr M. Mutignani declare that they have no conflict of interest.

Supplementary material

10388_2018_606_MOESM1_ESM.mp4 (28 mb)
Video. The video shows the endoscopic flexible cricopharyngeal myotomy step-by-step from thediverticuloscope positioning to the endoclips’ firing. Supplementary material 1 (MP4 28714 kb)


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Copyright information

© The Japan Esophageal Society and Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Digestive and Operative Endoscopy UnitNiguarda-Ca’ Granda HospitalMilanItaly
  2. 2.Mininvasive and Oncological SurgeryNiguarda-Ca’ Granda HospitalMilanItaly
  3. 3.AIMS-Advance International Mininvasive Surgery AcademyMilanItaly

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