Submucosal Injection-Guided Septotomy (SING) for the Treatment of Zenker's Diverticulum: A Multicenter Study of Over 100 Procedures (With Video).

BACKGROUND AND AIM: We present the first experience with the submucosal injection-guided septotomy (SING) technique, which integrates the principles of flexible endoscopic septotomy with submucosal endoscopy, applied in different phases of the procedure for the treatment of Zenker's diverticulum (ZD).

METHODS

Prospectively collected data from consecutive ZD patients treated with SING at three Italian centers (October 2019-August 2024) were analyzed. The primary outcome was clinical success (CS; Kothari-Haber Score < 2 at 3 months), whereas secondary outcomes included technical success (TS), procedural time, adverse events (AEs), hospital stay, and time to recurrence (Kaplan-Meier method). We also performed subgroup analysis according to ZD dimension (large vs. small) and to soft diverticuloscope use.

RESULTS

A total of 102 patients underwent SING (median age 74 years [IQR 68-81]; 69.7% male). Median diverticulum depth was 30 mm (IQR 25-40) and baseline KHS score 4 (IQR 3-6). CS was achieved in 98% (95% CI 93.6%-99.8%), with 7% (95% CI 2.9%-13.9%) experiencing symptom recurrence over a median follow-up of 370 days (IQR 297-747). Recurrence-free probabilities were 93.5% at 6 months, 92.0% at 12 months, and 92.0% at 24 months. TS was 100%, median procedural time 30 min (IQR 25-45), and AEs occurred in 3 patients (2.9%), all managed endoscopically.

CONCLUSIONS

SING is a safe and effective endoscopic treatment for ZD. Prospective comparative studies with standard techniques are warranted.