635. FLEXIBLE ENDOSCOPIC SEPTUM DIVISION FOR ZENKER’S DIVERTICULUM: A SINGLE CENTRE EXPERIENCE

Abstract Background Zenker diverticulum (ZD) is a pseudodiverticulum of the Killian’s triangle and usually affects males in the 6th-9th decade of life. Symptoms include dysphagia, regurgitation, chronic cough, aspiration, halitosis, and weight loss. The treatment of symptomatic ZD is operative and can surgical or endoscopic. Flexible endoscopic septum division is becoming a prominent treatment option for Zenker's diverticulum (ZD). We report our experience with Flexible endoscopic septum division. Methods Data on all consecutive patients that underwent flexible endoscopic treatment for symptomatic Zenker’s diverticulum from February 2021 to December 2023 were retrieved. All patients were diagnosed trough both barium esophagogram and EGDS. All procedures were performed in our centre by the same endoscopist. Dysphagia, regurgitation, and respiratory symptoms severity before the procedure were graded with the Kothari-Haber Scoring System (KH SS). Complications, LOS, symptoms scores and recurrences were recorded. Follow up was performed trough clinical and radiological evaluation. Results 19 patients were included, 16 (84%) men, mean age 77.2 years (53-79). Pre-operative mean symptoms score was 6.1 (4-9). The pre-operative mean pouch size was 4,16 cm (range 2,3-6). Median length of stay was 3 days (2-18). One patient had an oesophageal leak that was managed endoscopically with clip positioning, nasogastric tube, fasting, and antibiotics, with satisfactory long term clinical outcome. No other complications were reported. All patients reported significant symptom improvement, median post-operative symptoms score was 0,3 (0-3). Mild relapsing symptoms were present in two patients (10,5%), at 12 and 35 months. Both patients refused further treatments for recurrence. Conclusions Treatment of ZD with flexible endoscopic septum division is a feasible, safe and effective option with satisfactory long-term results.