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Endoscopic stapling versus laser for Zenker diverticulum: a retrospective cohort study

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Abstract

Purpose

Despite the evolution of the endoscopic techniques for the treatment of symptomatic Zenker diverticulum, comparative studies are lacking. Aim of this observational study was to compare safety, efficacy, and outcomes of endoscopic stapling (ES) versus Laser (EL).

Methods

A prospectively collected database of patients who underwent treatment for Zenker diverticulum at a single institution was reviewed. Consecutive patients treated by ES or EL were included in the study. Demographic data, presenting symptoms, diverticulum characteristics, and intra- and postoperative data were analyzed. The Functional Outcome Swallowing Scale (FOSS) and MD Anderson Dysphagia Inventory (MDADI) questionnaires were administered to assess severity of dysphagia and quality of life before and after treatment.

Results

Between March 2017 and September 2018, 36 patients underwent ES or EL. In the TL group (n = 19), the diverticulum size was smaller compared to the EL group (n = 17) (p = 0.002). Two perforations occurred in the EL group, one treated conservatively and the other requiring drainage of a mediastinal abscess. At a median follow-up of 16 months, symptoms improved in both groups but the number of patients with a postoperative FOSS score ≥ 2 significantly decreased only after EL (p < 0.001). The scores of all items of the MDADI questionnaire significantly increased in both groups, but the average delta values were greater in the EL patients (p < 0.001).

Conclusions

Both TL and ES are effective treatment options for Zenker diverticulum. Postoperative quality of life was significantly higher in patients undergoing EL compared to ES.

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Fig. 1

Availability of data and material

The datasets generated are available from the corresponding author on reasonable request.

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Funding

This study was not funded.

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Authors and Affiliations

  1. Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Piazza Malan 1, 20097, San Donato Milanese, Milan, Italy

    Simone Zanghì, Stefano Siboni, Emanuele Asti & Luigi Bonavina

Authors
  1. Simone Zanghì
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  2. Stefano Siboni
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  3. Emanuele Asti
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  4. Luigi Bonavina
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Contributions

SZ, SS, and EA made substantial contributions to conception and design of the study, acquisition and data analysis, and drafted the manuscript. LB made substantial contribution in data interpretation and critical revision of the manuscript for important intellectual contents. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Luigi Bonavina.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

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Written informed consent was obtained from all individual participants included in the study.

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Full consent to publish deidentified data was obtained by all patients.

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Zanghì, S., Siboni, S., Asti, E. et al. Endoscopic stapling versus laser for Zenker diverticulum: a retrospective cohort study. Eur Arch Otorhinolaryngol 278, 2625–2630 (2021). https://doi.org/10.1007/s00405-020-06346-4

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  • DOI: https://doi.org/10.1007/s00405-020-06346-4

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