Gastrointestinal: Endoscopic septoplasty for Zenker's diverticulum in a nonagenarian
Bibliographic record
Abstract
This case reports on an elderly patient with symptomatic Zenker's diverticulum who was successfully treated with endoscopic septoplasty. A 91 year old male presented with recurrent dysphagia to solids, regurgitation associated with coughing and choking attacks. The symptoms had been present for approximately 12 months and were recently becoming more bothersome. Barium swallow suggested a Zenker's diverticulum (Figure 1a). Initial oesophagogastroduodenoscopy (OGD) confirmed a 20 mm Zenker's diverticulum with some retained food debris. The patient was referred for a surgical opinion, however he was deemed not to be a surgical candidate. The surgical team referred the patient to our unit for consideration of endoscopic treatment. We repeated OGD under conscious sedation with titrated doses of Midazolam and Fentanyl and identified the diverticulum (Figure 1b, black arrow) and the septum (Figure 1B, white arrow). After insertion of a nasogastric tube into the stomach we performed endoscopic myotomy with a needle knife (Figure 1c, white arrow). When the myotomy was completed an Olympus endoclip was placed at the apex of the incision. The patient was discharged from hospital on the same day without any complication. Due to residual symptoms, the procedure was repeated three months later and the myotomy extended. Following the second procedure he had complete symptom resolution and was able to consume a normal diet. He has remained symptom free after 18 months of follow-up. Surgery is the mainstay of treatment for patients with a symptomatic Zenker's diverticulum and is associated with symptom resolution in up to 96%. The surgical options include open diverticulectomy or diverticulopexy with cricopharyngeal myotomy or alternatively endoscopic stapling. In symptomatic non-operative candidates or patients unwilling to undergo surgery, endoscopic Zenker's septoplasty is safe alternative with acceptable outcomes. Studies report complete symptom resolution in up to 82% of patients and a low complication rate with major complications (perforation, neck abscess) in 1.6% and minor complications in 6.1%. Mortality from this procedure has not been reported in the literature. Due to the nature of the procedure there is a learning curve, however this learning curve is unknown, and the opportunity for training is limited. An animal model has been described that may allow for further training in this technique and potentially more widespread application. Contributed by
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".