ArticleVideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy2026
Peroral endoscopic tunneling stricturotomy for diverticulum treatment: novel procedure for pediatric esophageal anastomotic diverticula.
Article in VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and Aims: This case details an 8-year-old female patient with a type C tracheoesophageal fistula and esophageal atresia who developed a symptomatic diverticulum proximal to an anastomotic scar band. This patient underwent diverticular-peroral endoscopic tunneling stricturotomy (D-POETS), a novel procedure for management of symptomatic postoperative diverticula refractory to incisional therapy and balloon dilation. Methods: Before the D-POETS procedure, an intraoperative esophagram showed an anastomotic diameter of 18 mm and a proximal diverticulum extending 1 cm below the anastomotic scar band. A mucosal bleb was formed 3 cm proximal to the diverticulum using a methylene blue and saline solution. A mucosotomy was created for submucosal hydrodissection and tunneling using a Hybrid T-type knife (Erbe, Tübingen, Germany). As the endoscope approached the scar band, the easily dissectible submucosal connective tissue transitioned to disorganized scar fibers and a difficult dissection plane. Results: At its conclusion, the tunnel length measured 3.5 cm and extended 5 mm distal to the scar band. After the stricturotomy, the scar band had an improved diameter (21 mm) with improved esophageal contour. At 8 months postoperatively, the patient's solid food dysphagia remained resolved. Conclusions: To our knowledge, the D-POETS technique is the first reported use of endoscopic third-space submucosal tunneling for stricturotomy of an anastomotic diverticulum.
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