Delgado Lucas Monteiro, Meine Gilmara Coelho, Santo Paula, Magalhães Caio Mendonça, Pimenta de Figueiredo Vitor Lauar, Ramos Josue Aliaga, Arantes Vitor Nunes
Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Division of Gastroenterology, Department of Internal Medicine, Feevale University, Novo Hamburgo, Brazil.
Gastrointest Endosc. 2025 Apr;101(4):751-761.e30. doi: 10.1016/j.gie.2024.11.043. Epub 2024 Nov 26.
Zenker's diverticulum (ZD) is the most common type of esophageal diverticulum. We conducted a systematic review and meta-analysis to compare the effectiveness and safety of endoscopic submucosal tunneling techniques (ESTTs) and flexible endoscopic septotomy (FES) for treating patients with ZD, including subgroup analyses by follow-up duration (<12 months and ≥12 months), diverticulum size (<2.5 cm and ≥2.5 cm), ESTT used (Zenker's peroral endoscopic myotomy and peroral endoscopic septotomy), and publication format (full text and abstract).
We searched PubMed, EMBASE, and Cochrane Library databases until June 20, 2024. Mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were pooled for continuous and binary outcomes, respectively. Heterogeneity was assessed with the I statistics.
We included 9 studies (759 patients). Compared with FES, ESTT had a higher probability of clinical success (RR, 1.15; 95% CI, 1.04-1.28). The results were similar in both groups for clinical recurrence (RR, .56; 95% CI, .29-1.07), technical success (RR, .99; 95% CI, .97-1.01), operative time (MD, 7.22 minutes; 95% CI, -.33 to 14.76), hospital stay (MD, .47 days; 95% CI, -1.25 to 2.19), and overall adverse events (RR, 1.19; 95% CI, .44-3.18). Subgroup analyses showed consistent results.
ESTT demonstrated a higher probability of clinical success and showed a trend toward a lower recurrence rate compared with FES; however, both groups had similar technical success, operative time, length of hospital stay, and overall adverse events. These findings underscore ESTT as an effective and safe method for treating patients with ZD.
Zenker憩室（ZD）是最常见的食管憩室类型。我们进行了一项系统评价和荟萃分析，以比较内镜黏膜下隧道技术（ESTTs）和软性内镜下憩室切开术（FES）治疗ZD患者的有效性和安全性，包括按随访时间（<12个月和≥12个月）、憩室大小（<2.5 cm和≥2.5 cm）、使用的ESTT（Zenker经口内镜肌切开术和经口内镜憩室切开术）以及发表形式（全文和摘要）进行亚组分析。
我们检索了截至2024年6月20日的PubMed、EMBASE和Cochrane图书馆数据库。分别汇总连续型和二分类结局的平均差（MDs）和风险比（RRs）及其95%置信区间（CIs）。采用I²统计量评估异质性。
我们纳入了9项研究（759例患者）。与FES相比，ESTT临床成功的概率更高（RR，1.15；95%CI，1.04 - 1.28）。两组在临床复发（RR，0.56；95%CI，0.29 - 1.07）、技术成功（RR，0.99；95%CI，0.97 - 1.01）、手术时间（MD，7.22分钟；95%CI， - 0.33至14.76）、住院时间（MD，0.47天；95%CI， - 1.25至2.19）和总体不良事件（RR，1.19；95%CI，0.44 - 3.18）方面的结果相似。亚组分析显示结果一致。
与FES相比，ESTT临床成功的概率更高，且复发率有降低趋势；然而，两组在技术成功、手术时间、住院时间和总体不良事件方面相似。这些发现强调了ESTT是治疗ZD患者的一种有效且安全的方法。
