Cricopharyngeal myotomy using grasping scissors: Benefits of peroral endoscopic myotomy in symptomatic Zenker’s diverticulum

Background and study aims: Multiple therapeutic modalities, including surgery and rigid and flexible endoscopy, have been adopted to manage Zenker’s diverticulum (ZD). Relief from symptoms such as dysphagia and regurgitation is the main goal of therapy in symptomatic ZD. This study was the first large cohort that aimed to assess efficacy with time and safety of endoscopic diverticulotomy using the Clutch Cutter. Patients and methods: Cricopharyngeal myotomy was performed in 43 patients at Hospital Saint Joseph de Paris, a tertiary referral center. Symptoms were analyzed before and at 3, 6, and 12 months post-intervention using an extensive questionnaire about dysphagia, odynophagia, regurgitation, chronic cough, state of health, and complications. Procedure details such as duration, complications, and technical success were recorded. Results: Mean size of ZD was 25.6 mm. Mean procedure time was 48 minutes. No major complications (e.g., perforation, mediastinitis) occurred, although one patient suffered from a sinus piriform wound. Follow-up was performed at 3, 6, and 12 months. During follow-up consultations, patients rated improvement in their symptoms as a percentage. At 12 months, 97% of patients reported 100% improvement. Conclusions: In patients with treatment-naïve ZD, the Clutch Cutter technique is safe, fast, and provides durable symptom remission.