Su1120 ENDOSCOPIC TREATMENT OF ZENKER′S DIVERTICULUM WITH SB-KNIFE IS AN EFFECTIVE, SAFE AND EASY PROCEDURE: A MULTICENTER SPANISH EXPERIENCE

SB-Knife (Sumitomo Bakeliteco., Ltd., Tokyo, Japan) is a monopolar cutting device inserted through the scope. This device has been tested for endoscopic treatment of Zenker′s diverticulum (ZD) in a small number of patients. The aim of the present study was to review our experience in order to assess the efficacy and safety for endoscopic treatment of ZD with SB-Knife. Patients that underwent flexible endoscopic treatment for ZD with the use of the SB-Knife were included. Epidemiological, clinical and technical data, rate of complications, symptom changes after the procedure and opinion of endoscopists were recorded. A total of 33 patients (24 men; median age: 71 years; range 48-84 years) from 14 hospitals were included. Five patients had previously been treated by endoscopy. The mean size of diverticulum was 4 cm (range: 1-7 cm). The most common symptom before treatment was dysphagia (grade 3 or 4) (63%). In 22 cases (66%) a soft diverticuloscope (Cook Medical. Bloomington IN, USA) was used. The mucomyotomy was performed using blend electrosurgical current in 30 (91%) or pure coagulation in 3 cases. Endoscopic clipping of the dissection line was performed in 29 patients (87%). In 5 cases (15%) a minor bleed occurred during treatment. In all cases, coagulation with SB-Knife was successful. After treatment we observed 4 complications: three minor adverse events (1 patient with severe pain and 2 with fever) and one perforation that was treated endoscopicaly, with antibiotics and parenteral nutrition without further complications. Median follow-up after treatment was 79 days (range 14-390 days). In all patients the symptoms improved with absence or minor dysphagia (grade 0-1). Endoscopists participating in the study believe that the use of SB-Knife is easy and makes the endoscopic treatment of ZD more simple. Endoscopic treatment of ZD with SB-Knife is an effective, safe and easy procedure. Studies directly comparing SB-Knife versus other cutting devices for treatment of ZD are warranted.