Endoscopic treatment of Zenker's diverticulum by harmonic scalpel

Hondo, Fábio Y.; Maluf‐Filho, Fauze; Giordano-Nappi, José Humberto; Neves, Carla Zanelatto; Cecconello, Ivan; Sakai, Paulo

doi:10.1016/j.gie.2011.05.007

Cited by 36 publications

(25 citation statements)

References 17 publications

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“…Both open transcervical and endoscopic approaches are associated with complications and potential risks. Nowadays, endoscopic surgery is the first approach 33, but surgery still has its utility in the treatment of Zenker’s diverticulum 34. An incomplete myotomy is associated with a higher degree of symptomatic recurrence 35 36 37 38 39.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic versus surgical approach in the treatment of Zenker’s diverticulum: systematic review and meta-analysis

et al. 2016

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Background: Zenker?s diverticulum is a rare disease in the general population. Its treatment can be carried out by either an endoscopic or surgical approach. The objective of this study was to systematically identify all reports that compare both treatment modalities and to assess the outcomes in terms of length of procedure, length of hospitalization, time until diet introduction, complication rates, and recurrence rates. Methods: A search of Medline and Embase selected all studies that compared different methods of surgical and endoscopic treatment for Zenker?s diverticulum published in the English, Portuguese, and Spanish languages between 1975 and 2014. The meta-analysis was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Data were extracted and analyzed for five different outcomes. Results: Eleven studies met the inclusion criteria, describing outcomes of endoscopic versus surgical treatment for 596 patients with Zenker?s diverticulum. A meta-analysis of the studies suggested a statistically significant reduction in operating time and length of hospitalization, favoring endoscopic treatment (standardized mean difference (SMD)???78.06, 95?%CI???90.63,???65.48 and SMD???3.72, 95?%CI???4.49,???2.95, respectively), just as with the reduction in the fasting period (SMD???4.30, 95?%CI???5.18,???3.42) and risk of complications (SMD???0.09, 95?%CI 0.03, 0.43) for patients who had undergone the endoscopic approach in comparison with the surgical group.?Also, a statistically significant reduction in the risk of symptom recurrence was seen when the treatment of Zenker?s diverticulum was carried out by a surgical approach compared with endoscopic treatment (SMD 0.08, 95?%CI 0.03, 0.13). Conclusion: Compared with a surgical approach, endoscopic treatment appeared to result in a shorter length of procedure and hospitalization, earlier diet introduction, and lower rates of complications, but in higher rates of symptom recurrence.

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Section: Discussionmentioning

confidence: 99%

Endoscopic versus surgical approach in the treatment of Zenker’s diverticulum: systematic review and meta-analysis

et al. 2016

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“…The harmonic scalpel uses ultrasonographic energy to coagulate and seal tissue before dividing it [94,95].…”

Section: Reviewmentioning

confidence: 99%

“…Recently published technique uses a harmonic scalpel with a soft 'diverticuloscope' (ZD overtube, ZDO-22-30; Cook Endoscopy, Winston-Salem, NC, USA) (FigurE 9) [95]. With the flexible endoscope in the esophagus the 'diverticuloscope' is inserted and positioned to allow better exposure of the septum and provide wall protection.…”

Section: Specific Techniquesmentioning

confidence: 99%

Flexible endoscopic and surgical management of Zenker's diverticulum

Dzeletovic

Ekbom

Baron

2012

Expert Review of Gastroenterology & Hepatology

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“…As another dissecting device, the blades operate ultrasonically and have the ability to simultaneously cut and coagulate tissue, causing vessel tamponade . Other potential advantages include better exposure of the septum, improved procedural accuracy and safety, and wall protection offered by the diverticuloscope. Success rates from small series have been reported at 80–100% .…”

Section: Evolution Of Devicesmentioning

confidence: 99%

“…Other potential advantages include better exposure of the septum, improved procedural accuracy and safety, and wall protection offered by the diverticuloscope. Success rates from small series have been reported at 80–100% . In the largest cohort studied ( N = 25), Fama et al .…”

Section: Evolution Of Devicesmentioning

confidence: 99%

New and emerging techniques for endoscopic treatment of Zenker's diverticulum: State‐of‐the‐art review

Ishaq

Sultan

Siau

et al. 2018

Digestive Endoscopy

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Zenker's diverticulum (ZD), or pharyngeal pouch, is an anatomical defect characterized by herniation of the posterior pharyngeal wall through Killian's dehiscence, and may result in dysphagia and regurgitation. Multiple therapeutic modalities including surgery, rigid and flexible endoscopy have been developed to manage ZD. Although surgical management with open and endoscopically assisted techniques have historically been the mainstay of ZD treatment, minimally invasive flexible endoscopic techniques, carried out under conscious sedation, are increasingly favored. Over the last two decades, the advent of new accessories and techniques have changed the landscape of endotherapy for ZD, with the current armamentarium including, but not limited to, endoscopic stapling, CO laser, argon plasma coagulation, needle knife, bipolar forceps, hook knife, clutch cutter, stag beetle knife, and submucosal tunneling endoscopic septum division. We hereby review the latest evidence to support the endoscopic management of ZD.

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Endoscopic treatment of Zenker's diverticulum by harmonic scalpel

Cited by 36 publications

References 17 publications

Endoscopic versus surgical approach in the treatment of Zenker’s diverticulum: systematic review and meta-analysis

Endoscopic versus surgical approach in the treatment of Zenker’s diverticulum: systematic review and meta-analysis

Flexible endoscopic and surgical management of Zenker's diverticulum

New and emerging techniques for endoscopic treatment of Zenker's diverticulum: State‐of‐the‐art review

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