Evaluation of endoscopic harmonic diverticulostomy.

Area of Science:

• Gastroenterology
• Surgical Technology
• Digestive Endoscopy

Background:

• Zenker's diverticulum is a condition requiring surgical intervention.
• Endoscopic diverticulostomy is a minimally invasive treatment option.
• Evaluating new technologies like Harmonic ultrasonic surgical instrumentation is crucial for patient outcomes.

Purpose of the Study:

• To compare the safety and efficacy of Harmonic ultrasonic surgical instrumentation versus endoscopic staplers for Zenker's diverticulum repair.
• To assess the optimal application of Harmonic technology in endoscopic diverticulostomy.

Main Methods:

• Retrospective review of patients undergoing endoscopic diverticulostomy for Zenker's diverticulum.
• Comparison of outcomes between staple-assisted (ENDO GIA) and Harmonic-assisted techniques.
• Data collected from a single tertiary academic hospital between April 2009 and December 2010.

Main Results:

• Sixty-five endoscopic diverticulostomies were performed: 24 Harmonic-assisted and 41 stapler-assisted.
• The complication rate was significantly higher in the Harmonic-assisted group (25%) compared to the staple-assisted group (4.88%) (P = .04).
• Complications included pharyngeal leaks, recurrence, chest pain, and subcutaneous emphysema; no complications occurred in diverticula smaller than 2 cm.

Conclusions:

• Endoscopic Harmonic esophagodiverticulostomy is associated with a significantly higher complication rate than staple-assisted methods for Zenker's diverticulum.
• Current data do not support the recommendation of Harmonic diverticulostomy for the majority of cases.
• Further validation studies are warranted to confirm these findings and guide clinical practice.