Evolving Management of Zenker’s Diverticulum in the Endoscopic Era: A North American Experience

Jones, D. G.; Aloraini, Abdullah; Gowing, Stephen; Cools-Lartigue, Jonathan; Leimanis, Mara L.; Tabah, Roger; Ferri, Lorenzo

doi:10.1007/s00268-016-3442-0

Cited by 22 publications

(16 citation statements)

References 31 publications

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“…18 In the intervening 25 years, these numbers seem largely unchanged, with relatively low mean numbers of annual endoscopic pouch surgical procedures undertaken by our peripheral units compared to our tertiary unit (four and nine procedures respectively). These numbers are comparable to annual pharyngeal pouch procedure numbers reported in recent case series from other parts of the world, including Las Vegas (n = 8), 19 Montreal (n = less than 3), 20 Tel Aviv (n = 8), 21 Sydney (n = 11), 22 Victoria (Australia) (n = 11), 23 Hull (UK) (n = 8) 24 and Oxford (n = 13). 25 We can compare the trends demonstrated in these publications with current trends in Hospital Episodes statistics.…”

Section: Comparisons With Other Studiessupporting

confidence: 79%

A multi-centre analysis of a decade of endoscopic pharyngeal pouch surgery in Cheshire and Merseyside

et al. 2020

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Background There are sparse data on the outcomes of endoscopic stapling of pharyngeal pouches. The Mersey ENT Trainee Collaborative compared regional practice against published benchmarks. Methods A 10-year retrospective analysis of endoscopic pharyngeal pouch surgery was conducted and practice was assessed against eight standards. Comparisons were made between results from the tertiary centre and other sites. Results A total of 225 procedures were performed (range of 1.2–9.2 cases per centre per year). All centres achieved 90 per cent resumption of oral intake within 2 days. All centres achieved less than 2-day hospital stays. Primary success (84 per cent (i.e. abandonment of endoscopic stapling in 16 per cent)), symptom resolution (83 per cent) and recurrence rates (13 per cent) failed to meet the standard across the non-tertiary centres. Conclusion Endoscopic pharyngeal pouch stapling is a procedure with a low mortality and brief in-patient stay. There was significant variance in outcomes across the region. This raises the question of whether this service should become centralised and the preserve of either tertiary centres or sub-specialist practitioners.

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Section: Comparisons With Other Studiessupporting

confidence: 79%

A multi-centre analysis of a decade of endoscopic pharyngeal pouch surgery in Cheshire and Merseyside

et al. 2020

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“…Two of the rigid and 1 of the flexible group had recurrent dysphagia in less than 2 years. In Jones et al, 16 6 of 15 rigid cases were converted to open with an additional case due to a perforation compared with 5 of 20 in the flexible group. There were no other adverse events reported except ''minor'' events (2 rigid, 1 flexible).…”

Section: Discussionmentioning

confidence: 98%

“…This systematic review and meta-analysis were originally undertaken with the purpose of analyzing the results of studies that compared rigid with flexible approaches, but even after more than 20 years of experience with the newer approach, only 2 of these studies were encountered. 16,22,23 A comparison of 30 patients after rigid endoscopic diverticulotomy vs 28 after flexible endoscopic diverticulotomy was presented by Repici et al 23 in 2011. Their groups had similar complication rates (1 perforation per group) and length of hospital stay.…”

Section: Discussionmentioning

confidence: 99%

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

Crawley

Dehom

Tamares

et al. 2019

Otolaryngol.--head neck surg.

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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.

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“…Several authors claim small diverticula < 3 cm should not be treated endoscopically[25,26] and that the percentage of asymptomatic patients with small diverticula is higher after open procedures than after endoscopic treatment[27]. In small diverticula a complete dissection of the cricopharyngeus muscle up to 4 cm can be impossible.…”

Section: Discussionmentioning

confidence: 99%

New flexible endoscopic controlled stapler technique for the treatment of Zenker's diverticulum: A case series

Wilmsen

Baumbach

Stüker

et al. 2017

WJG

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AIMTo report about the combination and advantages of a stapler-assisted diverticulotomy performed by flexible endoscopy.METHODSFrom November 2014 till December 2015 17 patients (8 female, 9 male, average age 69.8 years) with a symptomatic Zenker diverticulum (mean size 3.5 cm) were treated by inserting a new 5 mm fully rotatable surgical stapler (MicroCutter30 Xchange, Cardica Inc.) next to an ultrathin flexible endoscope through an overtube. The Patients were under conscious sedation with the head reclined in left position, the stapler placed centrally and pushed forward to the bottom of the diverticulum. The septum was divided by the staple rows under flexible endoscopic control.RESULTSIn eleven patients (64.7%) the stapler successfully divided the septum completely. Mean procedure time was 21 min, medium size of the septum was 2.8 cm (range 1.5 cm to 4 cm). In four patients the septum was shorter than 3 cm, in seven longer than 3 cm. To divide the septum, averagely 1.3 stapler cartridges were used. Two minor bleedings occurred. Major adverse events like perforation or secondary haemorrhage did not occur. After an average time of two days patients were discharged from the hospital. In 6 patients (35.3%) the stapler failed due to a thick septum or insufficient reclination of the head. Follow up endoscopy was performed after an average of two months in 9 patients; 4 patients (44.4%) were free of symptoms, 5 patients (55.6%) stated an improvement. A relapse of symptoms did not occur.CONCLUSIONFlexible endoscopic Zenker diverticulotomy by using a surgical stapler is a new, safe and efficient treatment modality. A simultaneously tissue opening and occlusion prevents major complications.

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Evolving Management of Zenker’s Diverticulum in the Endoscopic Era: A North American Experience

Cited by 22 publications

References 31 publications

A multi-centre analysis of a decade of endoscopic pharyngeal pouch surgery in Cheshire and Merseyside

A multi-centre analysis of a decade of endoscopic pharyngeal pouch surgery in Cheshire and Merseyside

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

New flexible endoscopic controlled stapler technique for the treatment of Zenker's diverticulum: A case series

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