Mulder et al3 and Ishioka et al4 initially described diverticulotomy by using freehand endoscope manipulation. Sakai et al5 demonstrated that using a cap at the tip of the endoscope offers 3-MA datasheet better visualization of the septum. Evrard et al6 showed better exposition of the septum with the use of a soft diverticuloscope. The fear of bleeding during treatment prompted Mulder et al3 and 7 to use argon plasma coagulation (APC) instead of conventional current, requiring multiple sessions with the risk of inducing fibrosis.

The availability of a soft, plastic diverticuloscope that mimics the Van Overbeek diverticuloscope8 has allowed better septum exposure and endoscope stability without the risk of trauma associated with the use of the rigid instrument. Moreover, it allows an extended section of the septum and protects the airway from aspiration in nonintubated patients. A previous study showed that diverticulotomy with a flexible endoscope and soft diverticuloscope is an effective treatment for ZD,6 and another suggested that this treatment was safer and more effective than freehand

treatment.9 This initial experience RO4929097 clinical trial prompted us to modify the technique with systematic clipping of the bottom section at the end of the procedure to reduce the risk of perforation and improve hemostasis. We report our long-term results of ZD treatment by using flexible endoscopy assisted by the use of a soft diverticuloscope. This study was conducted in accordance with the ethical principles of the Declaration of Helsinki, in compliance with good clinical

practice and according to local regulations. This work was not supported financially or otherwise by any external sources. All patients gave informed consent after explanation of the technique. Ethical approval for the study was obtained from the Institutional Review Board from our center, reference P2010/353. All patients with ZD who were treated in our medical-surgical department between July 2002 and June 2011 were included in the study. None of them Liothyronine Sodium were included in our previous report.6 Files were reviewed retrospectively, and clinical data were recorded (demographics, symptoms, dysphagia score, endoscopic treatment technique, adverse events, and outcome). Adverse events are defined by the Cotton et al10 severity scoring system. Patients were asked to fill in a questionnaire to describe their symptoms and quantify dysphagia before and after treatment. Dysphagia scores 1 month after treatment were available only for patients who were seen in the outpatient clinic at that time. Because a significant number of patients came from abroad, early follow-up in them was performed by the referring physician, and results were not available at the time of data collection. The Dakkak and Bennett11 score of dysphagia (score 0, no dysphagia; score 1, dysphagia to solids; score 2, dysphagia to semi-solids; score 3, dysphagia to liquids; score 4, aphagia) was used to quantify dysphagia.