Systematic review on treatment of Zenker's diverticulum

This study was designed to compare rates of failure, revision and morbidity from endoscopic and open approaches as treatment for pharyngeal pouch. Systematic review was conducted using MEDLINE and PubMed databases. Search terms treatment, Zenker's, hypopharyngeal, pharyngeal, diverticulum, and pouch. There were no randomised clinical trials. Therefore, cohort and comparative studies with at least 10 patients in each arm, a follow-up of a least 12 months and reporting on all patients were included. Seventy-one studies met inclusion criteria. Diverticulectomy with or without cricopharyngeal myotomy comprised 33 studies (1,990 patients), and endoscopic stapler diverticulotomy was in 22 studies (1,089 patients). Failure of open and endoscopic approaches was 4.2 and 18.4%, respectively, and corresponding complication rates were 11 and 7%. Within endoscopic techniques, failure rates were 18.9% for stapler diverticulotomy and 21.7% for laser diverticulotomy. Corresponding complication rates were 4.3 and 7.9%. Flexible endoscopy techniques have a higher failure (29%) and overall complication rate (14.3%). Most reported complications for transcervical techniques relate to the recurrent nerve (3.4%) and salivary fistula (3.7%) and for endoscopic group emphysema (3.0%) and mediastinitis (1.2%). Operation-related deaths were infrequent in both groups, but more frequent with open approach (0.9 vs. 0.4%). Open approaches have more success but more complications than endoscopic techniques. Taking in account overall complications and failure rates, open approaches and stapler diverticulotomy yield different patterns, but are arguably comparable. In younger patients open approach is preferred, as well in patients with unfavourable anatomic conditions for endoscopic exposure. Flexible endoscopic techniques provide a suitable option for patients who do not tolerate general anaesthesia.