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Background: Complications of endoscopic treatment of pharyngoesophageal diverticulum (PED) such as bleeding and perforation occur in up to 15 % of cases. Our objective was to compare incision of the PED septum using the ultrasonic device (group H) with incision using electrical current (group M) in a pig model., Methods: Twenty domestic pigs were divided into groups H and M. The incision of the PED septum was performed using the ultrasonic device or using electrical current, respectively. The procedural time, complication rate, length of the border of the incised septum, and thermal tissue damage were compared between groups., Results: Mean time to divide the septum and total procedure time were significantly shorter in group H. Mean length of the border of the incised septum was significantly higher in group H. The lateral thermal spread caused by electrical current (group M) was more intense. Hemorrhage was exclusively observed in group M., Conclusion: Experimental endoscopic diverticulotomy using ultrasonic device was faster and caused less tissue damage when compared to electrical current.

Context: Endosonography-guided biliary drainage has been used over the last few years as a salvage procedure when endoscopic retrograde cholangiopancreatography fails. Malignant gastric outlet obstruction may also be present in these patients. We report the results of both procedures during the same session in patients with duodenal and biliary obstruction due to malignant disease., Methods: A retrospective review from a prospective collected database., Results: Technical success was achieved in all five patients; however, only three patients experienced relief of jaundice and gastric outlet obstruction., Conclusions: Endosonography-guided biliary drainage and duodenal stenting in the same session is feasible. However, severe complications may limit the procedure. This is a challenging procedure and should be done by experts with special attention to patient's selection.

Background: Zenker's diverticulum (ZD) is a rare condition with a reported prevalence of 0.01% to 0.11% in the general population. Endoscopic treatment consists of the division of the septum between the diverticulum and the esophagus, within which the cricopharyngeal muscle is contained. Diathermic monopolar current, argon plasma coagulation, and laser have been used to incise the muscular septum with satisfactory results. The main limitation of endoscopic treatment is the occurrence of complications. Perforation and hemorrhage are reported in as many as 23% and 10% of patients, respectively., Objective: The aim of this study was to use the technique of endoscopic diverticulotomy by using a harmonic scalpel in patients with ZD and to demonstrate the feasibility of using flexible and rigid devices in ZD treatment., Design: Case series study. Standard protocol was used for patient management, endoscopic procedure, and data collection., Setting: Single endoscopist demonstrating preliminary results., Patients: Five patients (4 men; median ± standard deviation [SD] age 69.6 ± 9.06 years, range 59-83 years) with ZD were treated with this technique. All patients reported dysphagia and halitosis. The diagnosis was based on clinical, endoscopic, and radiographic findings., Interventions: All patients received general anesthesia and were placed in the left lateral position. A standard videogastroscope (9.8 mm) and a stiff guidewire were used to insert and achieve an adequate exposure of the ZD septum. The septum was divided using a harmonic scalpel under thin endoscope (5.2 mm) visualization through a soft diverticuloscope., Main Outcome Measurement: Feasibility of an endoscopic technique by using rigid and flexible devices to treat ZD., Results: Four patients (80%) were successfully treated in 1 session. The median ± SD size of the diverticulum was 3.6 ± 0.89 cm (range 3-5 cm). Median ± SD procedure time was 17.33 ± 2.33 minutes (range 15-20 minutes) in 6 procedures. No hemorrhage or perforation occurred. One patient (20%) required a second session to complete dissection of the ZD septum. All patients demonstrated improvement of dysphagia score after treatment., Limitations: Small case series design., Conclusions: Endoscopic treatment of ZD by harmonic scalpel through a soft diverticuloscope was feasible and effective in this small case series. Larger studies are warranted to further evaluate this technique., (Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.)