Endoscopic septotomy of a magnet-induced neoseptum in a large mid-esophageal diverticulum.

septum in a large mid-esophageal diverticulum A 72-year-old man who was complaining of dysphagia, regurgitation, and difficulty with passage through the esophagus was diagnosed with a mid-esophageal diverticulum with a diameter of 40mm. A contrast esophagogram (●" Fig.1), a computed tomography (CT) scan (●" Fig.2), and an endoscopic examination revealed that the diverticulum had a narrow neck and was filled with food particles. Because of the patient’s age and comorbidities, which included coronary heart disease and hypertension, and his reluctance to undergo major surgery, non-surgical treatment options were explored. Inspired by a mini-series involving three cases [1], we attempted to use magnets to perform a fusion between the esophageal wall and the wall of the diverticula to induce a neoseptum. Once the neoseptum had been formed, it would be possible to perform septotomy with electrocautery and to widen the narrow neck so that food could washout easily, thereby avoiding obstructive symptoms. One of the ring-shaped magnets was stabilized in the gastric lumenwith a grasper and the other magnet was placed at the base of the diverticulum. The magnet in the diverticulum was held steady as the gastric magnet was pulled up through the esophageal lumen. When the two magnets reached the same plane, they were attracted to each other, thereby causing the base of the diverticulum to fuse with the esophageal wall (●" Fig.3). By 4 weeks after the procedure a neoseptum had been formed through the pressure and attraction between the magnets. Diverticular septotomy with a needleknife andmarsupialization of the diverticulum were performed without complications (●" Fig.4;●" Video1). After 10 days, the patient was asymptomatic and a repeat contrast esophagogram showed a diverticulum with a wide neck that allowed contrast material to evacuate easily (●" Fig.5). This report is the second in the literature detailing treatment of an esophageal diverticulum using endoscopic septotomy of a neoseptum induced by magnets. These endoscopic procedures allowed the patient to avoid major surgery with satisfactory results and no complications.