USA: Comparison of Surgical Treatments for Zenker Diverticulum

A recent review comparing three common techniques for Zenker diverticulum (ZD) treatment found the open, transcervical approach to be superior to endoscopic techniques.

According to the study, published in the journal JAMA Otolaryngology-Head & Neck Surgery, the open diverticulectomy with cricopharyngeal myotomy showed the lowest incidence of persistent or recurrent symptoms following surgery compared to the other two techniques (endoscopic stapler–assisted and CO₂ laser diverticulotomy).

Zenker diverticulum can cause dysphagia, and the symptoms can return or persist after surgery. This systematic review and network meta-analysis by Neel K. Bhatt, University of Washington School of Medicine, Seattle, and colleagues, appears to be the first to compare three common surgical techniques for ZD.

The researchers aimed to compare the three most common surgical techniques—endoscopic laser-assisted diverticulotomy, endoscopic stapler-assisted diverticulotomy, and transcervical diverticulectomy with cricopharyngeal myotomy—in adult patients with ZD.

For this purpose, the researchers searched published literature on September 21, 2018. The review included cohort studies or randomized clinical trials. Studies that included patients needing revision surgery or undergoing an alternative technique were excluded.

The Preferred Reporting Items for Systematic Reviews and Meta-analyses–Network Meta-analyses (PRISMA-NMA) checklist was used to report the study findings. Two authors independently reviewed the studies.

The primary outcome measure was the incidence of persistent or recurrent symptoms following surgery. The primary study outcome was planned before data collection began.

The search generated 529 studies. After applying inclusion and exclusion criteria, nine cohort studies remained, consisting of 903 patients treated with either laser-assisted diverticulotomy (n = 283), transcervical diverticulectomy (n = 150), or stapler-assisted diverticulotomy (n = 470).

Key Findings of the Study

• Between endoscopic laser-assisted diverticulotomy and open diverticulectomy, the open approach showed a statistically lower likelihood of persistent/recurrent symptoms following treatment (odds ratio [OR], 0.20).
• Comparing laser-assisted diverticulotomy with the stapler-assisted technique, there was not a significant difference between the two techniques (OR, 0.83).
• The consistency model for the network meta-analysis was supported.

"This systematic review and meta-analysis compared three common techniques for treating ZD. The open approach showed a decreased likelihood of persistent or recurrent symptoms following surgery compared with the two other techniques," concluded the authors.

The review titled, "Comparison of Surgical Treatments for Zenker Diverticulum: A Systematic Review and Network Meta-analysis," is published in the journal JAMA Otolaryngology-Head & Neck Surgery.

DOI: https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2773739