Endoscopic stapler versus laser diverticulotomy for Zenker's diverticulum: a systematic review and meta-analysis

Area of Science:

• Gastroenterology
• Surgical Innovation
• Comparative Effectiveness Research

Background:

• Zenker's diverticulum treatment traditionally involves open surgery.
• Minimally invasive endoscopic techniques, including stapler-assisted and laser diverticulotomy, offer alternatives.
• Assessing the comparative safety and efficacy of these endoscopic methods is crucial for clinical decision-making.

Approach:

• A systematic literature review and meta-analysis of English-language studies was conducted.
• Compared endoscopic stapler-assisted diverticulotomy with endoscopic carbon dioxide laser diverticulotomy for Zenker's diverticulum.
• Analyzed rates of pharyngeal perforation, major post-operative complications, and re-operation.

Key Points:

• Pooled analysis included 417 stapler-assisted and 413 laser diverticulotomy cases from nine retrospective studies.
• No significant difference was found in pharyngeal perforation rates between the two endoscopic techniques.
• Major complication rates and the need for re-operation were also comparable between stapler-assisted and laser diverticulotomy.

Conclusions:

• Both endoscopic stapler-assisted and carbon dioxide laser diverticulotomy are safe and effective endoscopic treatments for Zenker's diverticulum.
• These endoscopic approaches demonstrate similar adverse event profiles and efficacy.
• The choice between stapler-assisted and laser diverticulotomy should be guided by surgeon preference and experience, particularly for patients unsuitable for open surgery.