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Open Versus Endoscopic Surgery of Zenker’s Diverticula: A Systematic Review and Meta-analysis

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Abstract

Most Zenker’s diverticula (ZD) cohort studies are single-institution retrospective observational studies of recurrence rates. There is a gap in the literature regarding patient-reported outcomes after ZD surgery. This study was conducted to compare if open transcervical diverticulectomy (OD) is better than endoscopic laser diverticulectomy (ELD) or endoscopic stapler-assisted diverticulectomy (ESD). The study design is of systematic review and meta-analysis. The following databases were searched: SCOPUS, EMBASE, PubMed, and Word of Science through December 2017. The quality of the studies was evaluated using 22-item STROBE checklist with 3 independent physician reviewers. The Inter-rater reliability was calculated both as a percent and utilizing Cohen’s Kappa. For the meta-analysis, Cohen’s d for an effect size was calculated for all studies comparing dysphagia results before and after surgery. A total of 865 patients were treated across 11 selected publications, of which 106 patients were treated OD, 310 ELD, and 449 with an ESD approach. Patient-reported dysphagia outcomes were reported as Cohen’s d (confidence interval): OD, ELD, and ESD were 1.31 (0.88, 1.74), 1.91 (1.62, 2.20), and 2.45 (2.04, 2.86), respectively. The pooled effect of all studies for dysphagia was 2.22 (1.85, 2.59) and regurgitation 2.20 (1.80, 2.59). We did not prove that OD has superior outcomes compared to ESD and ELD. Any method of surgical intervention yields a large effect (i.e., improvement in dysphagia and regurgitation) comparing patient-reported symptoms before and after surgery. Future research, currently underway, includes a prospective, multi-institutional study comparing standardized outcomes between treatments of ZD including symptom resolution, complications, and recurrences using validated measures to define long-term outcomes.

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Acknowledgements

We would like to thank our librarian Mr. Don Jason for his expertise during our literature search. We would also like to thank Dr. Luigi Bonavina for providing additional details to meet our inclusion criteria.

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Authors and Affiliations

  1. Department of Otolaryngology Head and Neck Surgery, University of Cincinnati, Cincinnati, OH, USA

    Rebecca J. Howell, John Paul Giliberto, Jeffrey Harmon, Jessica Masch, Sid Khosla & Jareen Meinzen-Derr

  2. Department of Otolaryngology Head and Neck Surgery, Medical College of Georgia at Augusta University, Augusta, GA, USA

    Gregory N. Postma

  3. Department of Pediatrics, Department of Environmental Health, University of Cincinnati, Cincinnati, OH, USA

    Jareen Meinzen-Derr

  4. Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML #0528, Cincinnati, OH, 45267-0528, USA

    Rebecca J. Howell

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  1. Rebecca J. Howell
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Correspondence to Rebecca J. Howell.

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Howell, R.J., Giliberto, J.P., Harmon, J. et al. Open Versus Endoscopic Surgery of Zenker’s Diverticula: A Systematic Review and Meta-analysis. Dysphagia 34, 930–938 (2019). https://doi.org/10.1007/s00455-019-09994-9

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  • DOI: https://doi.org/10.1007/s00455-019-09994-9

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