Endoscopic division of a Zenker diverticulum using the Clutch Cutter

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Helmut Neumann and Andreas Nägel, Erlangen


Sequence 1 — inspection of the Zenker diverticulum

Endoscopic inspection of the Zenker diverticulum. Any food residues that may be present in the diverticulum are removed before further intervention.

Sequence 2 — positioning of a gastric tube and attachment of a 4-mm distancing cap

Positioning of a gastric tube and attachment of a 4-mm distancing cap to provide better visualization of the Zenker diverticulum.

Sequence 3 — introduction of the coagulation forceps / scissors

The septum of the diverticulum is demonstrated with the cap, and the Clutch Cutter is introduced. The instrument can be rotated 360 degrees by the assistant.

Sequence 4 — treatment for the Zenker diverticulum

Coagulation of the diverticular septum using the Clutch Cutter. Settings: forced coagulation 30 W, Endo Cut Q with an effect of 1, cutting duration 3, cutting interval 1.

Sequence 5 — perforation during the treatment

If cutting continues too far, the lumen opens up and a perforation can be seen. Carrying out the intervention using CO2 is therefore recommended.

Sequence 6 — closure of the perforation using clips

Resolution clips are placed to close the perforation. The perforation is completely closed with several clips in what is called the “zip” technique, and the gastric tube is left in place.

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