The safety and efficacy of endoscopic Zenker's diverticulotomy: A cohort study.

OBJECTIVES/HYPOTHESIS: To determine whether the application of laser-assisted techniques for the treatment of Zenker's diverticulum would reduce the failure rate of endoscopic procedures without compromising safety or durability.

STUDY DESIGN

Cohort study with long-term follow-up.

METHODS

We performed a single-institution review of 106 consecutive patients in whom endoscopic laser-assisted diverticulotomy (ELD) or endoscopic stapler-assisted diverticulotomy (ESD) was attempted. The Eating Assessment Tool was collected pre- and postoperatively. Long-term follow-up was conducted on average 2.4 years postoperatively.

RESULTS

The decision to use either ELD or ESD was made intraoperatively. An endoscopic procedure was successfully completed in 103 of 106 patients (97.2%). Eighty-three patients underwent ELD, 20 underwent ESD, and only three required use of an open approach. No serious complications occurred. Postoperatively, there was a significant reduction in dysphagia symptoms. At follow-up, most individuals had dysphagia scores within the normal range (69%) and were eating a regular diet (73%). Fourteen patients (14%) required revision. Compared to historical data from our institution for ESD alone, the addition of ELD resulted in a reduction in the failure rate without an increase in serious complications. Recurrence rates and long-term outcomes were equivalent.

CONCLUSION

Through careful patient selection, appropriate workup, and judicious use of techniques, it was possible to perform endoscopic surgery in a majority of patients without serious complications. Both approaches resulted in short- and long-term symptom management with high levels of satisfaction.

LEVEL OF EVIDENCE

4. Laryngoscope, 126:2705-2710, 2016.