Objective Fluoroscopic Outcomes After Endoscopic Staple Versus Laser Zenker's Diverticulotomy

Area of Science:

• Gastroenterology
• Surgical Technology
• Medical Imaging

Background:

• Zenker's diverticulotomy (ZD) is a procedure to treat Zenker's diverticulum.
• Endoscopic Zenker's diverticulotomy (EZD) is performed using either stapling (ESD) or CO2 laser (ELD).
• Optimal outcomes between ESD and ELD remain debated.

Purpose of the Study:

• To compare objective fluoroscopic data between endoscopic staple diverticulotomy (ESD) and endoscopic laser diverticulotomy (ELD).
• To evaluate the efficacy of each EZD technique in reducing diverticulum size.
• To assess postoperative swallowing function and pharyngeal mechanics.

Main Methods:

• Retrospective review of patients undergoing primary EZD from 2014-2022.
• Matching patients by preoperative diverticulum size for ESD and ELD groups.
• Primary outcomes: postoperative diverticulum size and change in size; Secondary outcomes: EAT-10, PAS, PCR, PESo.

Main Results:

• Thirteen matched pairs were analyzed.
• Both ESD and ELD significantly reduced diverticulum size.
• Endoscopic laser diverticulotomy (ELD) showed a greater reduction in diverticulum size compared to endoscopic staple diverticulotomy (ESD) (1.62 cm vs 1.14 cm, p<0.05).
• No significant differences were found in postoperative EAT-10, PAS, PCR, or PESo between the groups.

Conclusions:

• Endoscopic laser Zenker's diverticulotomy may lead to superior reduction in diverticulum size compared to endoscopic staple diverticulotomy.
• Neither technique demonstrated a significant difference in postoperative dysphagia symptoms or other fluoroscopic parameters.
• Further research may clarify long-term functional outcomes.