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

Abstract

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.

Zenker Diverticulum Treatment: Endoscopic or Surgical?

“…Also, doctors' preferences, training, and practice standards are important issues in the final decision. Last but not least, the wishes of the patient should be considered (9).…”

Endoscopic needle‐knife treatment for symptomatic esophageal Zenker’s diverticulum: A meta‐analysis and systematic review

“…Since an endoscopic stapler was introduced through a rigid scope, intraluminal approaches have tended to be superior to open‐neck surgical approaches, with comparable success rates and less traumatic injury. More recently, with different coagulation and cutting devices, the flexible endoscope approach was offered and recommended by some authors . However, the management of ZD is far from being standardized in current clinical practice.…”

Zenker’s diverticulum and squamous esophageal cancer: a case report

“…Zenker's diverticulum is a benign esophageal condition, quite rarely encountered in clinical practice with an annual incidence of two per 100,000 persons per year (1). The condition typically affects the elderly population in the seventh decade of life, being uncommon before the age of 40, and it is more frequently described in males than females (1,2).…”

“…The condition typically affects the elderly population in the seventh decade of life, being uncommon before the age of 40, and it is more frequently described in males than females (1,2). In fact, Zenker's diverticulum or pharyngeal pouch is a pulsion diverticulum that results from the herniation of the esophageal mucosa on the posterior wall between the cricopharyngeus muscle and the inferior pharyngeal constrictor muscle (3).…”

“…Morton and Bartney have devised a classification of diverticulosis based of dimension: small pouch (less than 2 cm), medium (between 2 cm and 4 cm), and large (more than 4 cm) (1,4). The majority of diverticula exhibit no symptoms and are discovered incidentally (5).…”