Endoscopic needle‐knife treatment for symptomatic esophageal Zenker’s diverticulum: A meta‐analysis and systematic review

Li, Lian Yong; Yang, Yuan Sheng; Qu, Chang Min; Liang, Shu Wen; Zhong, Chang Qing; Wang, Xiaoying; Chen, Yan; Spandorfer, Robert; Christofaro, Sarah; Cai, Qiang

doi:10.1111/1751-2980.12588

Cited by 26 publications

(22 citation statements)

References 27 publications

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“…The technique is safe, with 4% adverse events and 1% severe adverse event in our study, slightly lower than the 13% adverse event rate reported in a recent meta-analysis. 12 Although all complications in our work occurred after procedures using the diverticuloscope, aspiration pneumonia and pneumomediastinum cannot be definitively linked with the use of a diverticuloscope. Moreover, the "cap only" technique resulted in a comparable 4% complication rate in a previous study involving 26 patients.…”

Section: Discussionmentioning

confidence: 66%

“…The diverticuloscope was introduced with the flexible endoscopic septotomy technique to improve the safety of the procedure, by protecting the outer esophageal and diverticular wall from the needle knife . Most studies have reported the systematic use of the diverticuloscope . However, the diverticuloscope increases the cost of the procedure, may be traumatic or impossible to place in small ZD, and becomes less and less useful for endoscopists mastering ESD techniques, and able to precisely control any movement of the endoknife.…”

Section: Discussionmentioning

confidence: 99%

“…15 Most studies have reported the systematic use of the diverticuloscope. 12,16 However, the diverticuloscope increases the cost of the procedure, may be traumatic 20 or impossible to place in small ZD, and becomes less and less useful for endoscopists mastering ESD techniques, and able to precisely control any movement of the endoknife. Of note, the latest techniques of flexible endoscopic septotomy for ZD, such as a wedge-shaped excision of the wall called myectomy introduced by Pang et al, 9 do not include a diverticuloscope.…”

Section: Discussionmentioning

confidence: 99%

“…However, the recurrence rates range from 3% to 32% in the literature . This major heterogeneity may result from the variety of the endoscopic techniques used, using a diverticuloscope or a cap, different follow‐up durations, and analysis of patients with recurrent ZD …”

Section: Introductionmentioning

confidence: 99%

“…11 This major heterogeneity may result from the variety of the endoscopic techniques used, using a diverticuloscope or a cap, different follow-up durations, and analysis of patients with recurrent ZD. 12 Our aim was to report a single center experience in the endoscopic treatment of ZD with long-term follow-up data. We compared initial and long-term success rates, among different endoscopic treatment modalities and naïve or recurrent ZD.…”

Section: Introductionmentioning

confidence: 99%

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Do we still need a diverticuloscope for the flexible endoscopic septotomy of Zenker's diverticulum?

Bresteau

Barret

Guillaumot

et al. 2019

J of Gastro and Hepatol

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Background and Aim Zenker's diverticulum (ZD) is the most common type of diverticulum in the esophagus. The endoscopic septotomy of the diverticular wall has become a widely accepted treatment modality, but the recurrence rate is unclear. Our aim was to assess short‐term and long‐term success rates after flexible endoscopic septotomy for the treatment of ZD. Methods All consecutive patients treated at our department for a ZD between November 2014 and September 2018 were included. Endoscopic septotomy was conducted using a diverticuloscope or a distal attachment cap. Data were retrospectively analyzed from a prospectively collected database. We collected data concerning patients, endoscopic procedures, and short‐term clinical outcomes. All patients were reached by phone between October and December 2018 to assess long‐term results. Results Seventy‐seven patients were referred to our department for a ZD. Sixty patients were treated using a diverticuloscope and 17 patients with a distal attachment cap. For all 77 patients, the myotomy was technically successful. Three patients treated with a diverticuloscope reported complications. Initial treatment success was 93%. After a mean (±SEM) follow up of 23 ± 2 months, 66% of patients had persistent clinical remission. The rate of long‐term treatment success was 72% in treatment‐naïve and 50% in previously treated patients (P = 0.13). Treatment success was 68% in patients treated with the diverticuloscope versus 60% in the group treated with a cap (P = 0.75). Conclusion The flexible endoscopic septotomy for the treatment of ZD is a safe and effective treatment of ZD, with or without a diverticuloscope.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Do we still need a diverticuloscope for the flexible endoscopic septotomy of Zenker's diverticulum?

Bresteau

Barret

Guillaumot

et al. 2019

J of Gastro and Hepatol

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Per‐oral endoscopic myotomy as treatment for Killian–Jamieson diverticulum

et al. 2021

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Killian–Jamieson diverticulum (KJD) is a rare type of esophageal diverticulum less commonly encountered compared with Zenker's diverticulum (ZD). Endoscopic approach for these diverticula has been rapidly evolving. Currently, a flexible endoscopic septum division is considered the first‐line treatment for symptomatic ZD patients, however reported recurrence rates are over 10% according to recent literature. With the advent of submucosal tunneling technique established by per‐oral endoscopic myotomy for achalasia, it has been applied to treat ZD named as Zenker's diverticulum per‐oral endoscopic myotomy (Z‐POEM) as a minimally invasive treatment. Although there are very few reports utilizing submucosal tunneling approach to KJD, we have opted to perform Z‐POEM in order to safely perform complete dissection of the muscle septum while maintaining mucosal integration. Due to the difficulty of anatomical location of KJD, we created mucosal incision and subsequent submucosal tunnel directly at the level of the septum as opposed to creating a submucosal tunnel few centimeters proximal to the septum as being previously proposed. We report a case in which this technique was successfully performed with complete resolution of dysphagia without any adverse event. This technique permits to perform complete myotomies without the fear of causing perforation. Although larger cohorts are required to assess its safety and efficacy, Z‐POEM to treat KJD seems to be promising.

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Endoscopic Myotomy and Septotomy for Zenker’s Diverticulum (Z-POEM)

Fugazza

Cappello

Capogreco

et al. 2021

Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy

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Endoscopic needle‐knife treatment for symptomatic esophageal Zenker’s diverticulum: A meta‐analysis and systematic review

Abstract: Flexible endoscopic procedures using needle-knife offers a relatively safe and effective treatment of symptomatic ZD, especially for ZD of <4 cm in diameter.

Cited by 26 publications

References 27 publications

Do we still need a diverticuloscope for the flexible endoscopic septotomy of Zenker's diverticulum?

Do we still need a diverticuloscope for the flexible endoscopic septotomy of Zenker's diverticulum?

Per‐oral endoscopic myotomy as treatment for Killian–Jamieson diverticulum

Endoscopic Myotomy and Septotomy for Zenker’s Diverticulum (Z-POEM)

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