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Comparative Outcomes of Flexible Endoscopy, Rigid Endoscopy, and Open Surgery for the Zenker Diverticulum Repair: A
Akua Nuako1, Steven Steinway2, Bianca Zussino3
1Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Introduction:
Flexible endoscopy (FE), rigid endoscopy (RE), and open surgery (OS) are established treatments of Zenker diverticulum (ZD); however, comparative data on their clinical outcomes remain limited and inconsistent. We conducted the first multicenter matched cohort study comparing several procedural outcomes across FE, RE, and OS for ZD repair.
Methods:
The study population was matched for age, sex, American Society of Anesthesiologists score, and diverticulum. Size resulting in outcomes assessed included dysphagia scores, clinical and technical success, adverse events (AEs), procedure length, hospital length of stay, and need for further interventions. Both overall and pairwise comparisons were conducted. Subgroup analyses were performed to assess for comparative efficacy of FE procedure types, effect of previous intervention on procedure success, and the effect the year the procedure was performed on clinical success.
Results:
There were 202 eligible patients over the study period. Propensity score matching resulted in 125 patients (FE n = 44, RE n = 36, OS n = 45). FE demonstrated higher clinical success than RE (84.6% vs 55.6%, P = 0.032) and similar success to OS (88.9%, P = 0.712); OS showed higher success than RE ( P = 0.014). AE rates were lowest with FE (4.5%) compared with RE (8.3%) and OS (11.1%) although this was not statistically significant ( P = 0.212). FE had shorter median length of stay (0 days vs 1 day for RE and 3 days for OS, P < 0.001) and median procedure lengths (55 minutes vs 58 minutes for RE and 78 minutes for OS, P = 0.018).
Discussion:
In this matched cohort, FE has clinical success comparable with OS and superior to RE for ZD repair, with shorter hospital stays, reduced procedure lengths, and a trend toward fewer AEs. Our matched, multicenter design provides stronger comparative evidence than previous unmatched studies. These findings support FE as a first-line treatment of ZD repair, although prospective studies could further clarify long-term outcomes.
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