Adverse Events after Rigid and Flexible Endoscopic Repair of Zenker’s Diverticula: A Systematic Review and Meta‐analysis

Abstract

Objective To determine adverse events after endoscopic flexible vs endoscopic rigid cricopharyngeal myotomy for treatment of Zenker’s diverticulum (ZD). Data Sources Systematic review of MEDLINE, Web of Science, CINAHL, Clinicaltrials.gov, and Cochrane Central Register of Controlled Trials for all years according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Additional studies were identified from review citations and a by hand search of manuscripts referencing ZD. Review Methods A structured literature search was conducted to identify studies for this systematic review. Methodological Index for Non-randomized Studies (MINORS) criteria were applied to assess study quality. For inclusion, each study had to provide data for at least 10 adult patients who had undergone endoscopic ZD repair reporting clear association with the postprocedure course in each case. Data extracted included all reported adverse events, recurrences, follow-up, and operative times. Results In total, 115 studies were included. All but 8 were retrospective case series. Sixty-one reported series of patients after rigid endoscopic stapler repair, 31 after rigid laser repair, and 13 with other rigid endoscopic instruments. Twenty-nine flexible endoscopic studies were included. Mortality, infection, and perforation were not significantly more likely in either the rigid or the flexible group, but bleeding and recurrence were more likely after flexible endoscopic techniques (20% vs <10% and 4% vs 0%, respectively). Dental injury and vocal fold palsy were reported rarely in the rigid endoscopic groups. Conclusions Adverse events are rare after endoscopic Zenker’s repair. The flexible approach minimizes exposure limitations and can be completed in some patients without general anesthesia. Transoral rigid approaches result in fewer revision surgeries compared with flexible diverticulotomy.

Flexible Endoscopic Zenker’s Diverticulotomy with an Articulating Bipolar Energy Sealer

“…2 In a systematic review by Crawley et al comparing transoral rigid and flexible endoscopic approaches, both approaches had few adverse events, with somewhat higher recurrence rates in the flexible group. 3…”

“…2 In a systematic review by Crawley et al comparing transoral rigid and flexible endoscopic approaches, both approaches had few adverse events, with somewhat higher recurrence rates in the flexible group. 3 There is little published experience with bipolar energy sealer use in Zenker's diverticula. Andersen et al described use of the Ligasure (Medtronic, Dublin, Ireland), an alternative bipolar energy sealer, for use in transoral rigid diverticulotomy.…”

The role of upper GI flexible endoscopy in management of large pharyngeal pouches

“…The hypothesis was that we were able to locate the lumen, possibly because of the air insufflator in the non-stretch environment. 7 The open approach would also require a longer operating time and longer hospital stay along with increased risk of complications. Hence, the method used was identified as the best approach for our patient.…”

“…The other options were to use a flexible endoscopic approach or an open approach to remove the pouch. However, higher rates of post‐operative bleeding and recurrence have been observed with a flexible endoscopic approach 7 . The open approach would also require a longer operating time and longer hospital stay along with increased risk of complications.…”

“…The other options were to use a flexible endoscopic approach or an open approach to remove the pouch. However, higher rates 7 The open approach would also require a longer operating time and longer hospital stay along with increased risk of complications. Hence, the method used was identified as the best approach for our patient.…”