Revision Zenker diverticulum: laser versus stapler outcomes following initial endoscopic failure

Area of Science:

• Gastroenterology
• Surgical Innovation
• Medical Device Technology

Background:

• Recurrent Zenker diverticulum (ZD) poses challenges after initial endoscopic repair.
• Endoscopic management options for recurrent ZD include CO2 laser and stapler techniques.
• Evaluating the efficacy of revision endoscopic repairs is crucial for patient outcomes.

Purpose of the Study:

• To compare the outcomes of revision endoscopic repairs for recurrent Zenker diverticulum (ZD) using CO2 laser versus stapler methods.
• To analyze patient demographics, defect size, symptoms, and complications associated with revision ZD repairs.

Main Methods:

• Retrospective chart review of 148 patients undergoing endoscopic ZD repair (2000-2010).
• Focus on 12 patients with recurrent ZD requiring revision endoscopic repair (8 CO2 laser, 4 stapler).
• Assessment of dysphagia and regurgitation using modified scales; comparison of hospital stay and time to oral intake.

Main Results:

• No significant differences in age or defect size between CO2 laser and stapler revision groups.
• Revision stapler repair was associated with significantly longer hospital stays and delayed oral intake compared to primary stapler repair.
• CO2 laser revision demonstrated superior postoperative regurgitation scores.

Conclusions:

• Secondary endoscopic repair is an effective treatment for recurrent Zenker diverticulum.
• CO2 laser revision offers better symptom outcomes and faster recovery than stapler revision for recurrent ZD.
• Revision stapling may lead to prolonged hospitalization and delayed oral intake compared to primary stapling.