Endoscopic stapler versus laser diverticulotomy for Zenker's diverticulum: a systematic review and meta-analysis

A literature review and meta-analysis was performed to assess for difference in rate of complications and need for revision surgery between endoscopic stapler-assisted diverticulotomy and endoscopic carbon dioxide laser diverticulotomy. The hypothesis was that endoscopic stapler-assisted diverticulo...

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Bibliographic Details
Published in:Journal of laryngology and otology 2023-07, Vol.137 (7), p.718-724
Main Authors: Edwards, D, Prades, E, Thorne, C, Harris, A
Format: Article
Language:English
Subjects:
Bias
Carbon dioxide
Complications
Diverticulum
Endoscopy
Esophagoscopy - methods
Humans
Laser Therapy - adverse effects
Laser Therapy - methods
Lasers
Literature reviews
Meta-analysis
Patients
Pharyngeal Diseases - etiology
Pharynx
Postoperative
Retrospective Studies
Software
Statistical analysis
Surgeons
Surgery
Surgical techniques
Systematic review
Treatment Outcome
Zenker Diverticulum - surgery
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Summary:A literature review and meta-analysis was performed to assess for difference in rate of complications and need for revision surgery between endoscopic stapler-assisted diverticulotomy and endoscopic carbon dioxide laser diverticulotomy. The hypothesis was that endoscopic stapler-assisted diverticulotomy has a lower complication rate but endoscopic carbon dioxide laser diverticulotomy has a lower need for revision surgery. This was a systematic review of English-language studies comparing endoscopic stapler-assisted diverticulotomy and endoscopic carbon dioxide laser diverticulotomy for the treatment of Zenker's diverticulum. Meta-analysis of results with regard to rate of pharyngeal perforation, major post-operative complication and need for re-operation was performed. Nine retrospective studies were included with pooled analysis of 417 endoscopic stapler-assisted diverticulotomy and 413 endoscopic carbon dioxide laser diverticulotomy cases. Meta-analysis found no significant difference in rate of pharyngeal perforation, major complication or need for re-operation between the two groups. This study demonstrated both endoscopic stapler-assisted diverticulotomy and endoscopic carbon dioxide laser diverticulotomy to be a safe alternative to open surgery for Zenker's diverticulum. Both appear to be similar in terms of adverse events and efficacy. The authors recommend either approach, guided by surgeon's preference and experience, where patients are unsuitable for an open surgery approach.
ISSN:0022-2151
1748-5460
DOI:10.1017/S0022215122002377