Open Versus Endoscopic Surgery of Zenker’s Diverticula

A Systematic Review and Meta-analysis

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

Research output: Contribution to journalArticle

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. Level of Evidence 3.

Original languageEnglish (US)
JournalDysphagia
DOIs
StatePublished - Jan 1 2019

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Zenker Diverticulum
Deglutition Disorders
Meta-Analysis
Lasers
Recurrence
Checklist
PubMed
Observational Studies
Publications
Cohort Studies
Retrospective Studies
Databases
Confidence Intervals
Physicians

Keywords

  • Degluitition disorders
  • Deglutition
  • Dysphagia outcomes
  • Esophageal diverticulectomy
  • Surgical dysphagia
  • Zenker diverticulum

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Gastroenterology
  • Speech and Hearing

Cite this

Open Versus Endoscopic Surgery of Zenker’s Diverticula : A Systematic Review and Meta-analysis. / Howell, Rebecca J.; Giliberto, John Paul; Harmon, Jeffrey; Masch, Jessica; Khosla, Sid; Postma, Gregory N; Meinzen-Derr, Jareen.

In: Dysphagia, 01.01.2019.

Research output: Contribution to journalArticle

Howell, Rebecca J. ; Giliberto, John Paul ; Harmon, Jeffrey ; Masch, Jessica ; Khosla, Sid ; Postma, Gregory N ; Meinzen-Derr, Jareen. / Open Versus Endoscopic Surgery of Zenker’s Diverticula : A Systematic Review and Meta-analysis. In: Dysphagia. 2019.
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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. Level of Evidence 3.",
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