Endoscopic needle‐knife treatment for symptomatic esophageal Zenker’s diverticulum: A meta‐analysis and systematic review

• Published in: Journal of digestive diseases Vol. 19; no. 4; pp. 204 - 214
• Main Authors: Li, Lian Yong, Yang, Yong Tao, Qu, Chang Min, Liang, Shu Wen, Zhong, Chang Qing, Wang, Xiao Ying, Chen, Yan, Spandorfer, Robert M., Christofaro, Sarah, Cai, Qiang
• Format: Journal Article
• Language: English
• Published: Melbourne Wiley Publishing Asia Pty Ltd 01.04.2018; Wiley Subscription Services, Inc
• Subjects: Diverticulum; endoscopic treatment; Endoscopy; Esophagus; Meta-analysis; needle‐knife; Statistical analysis; systematic review; Zenker’s diverticulum; meta-analysis; endoscopic treatment; Zenker’s diverticulum; systematic review; needle-knife
• DOI: 10.1111/1751-2980.12588
• ISSN: 1751-2972

OBJECTIVE The aim of this study was to assess the efficacy and safety following endoscopic management of Zenker’s diverticulum (ZD) using a needle‐knife technique. METHODS A systematic search of PubMed, Embase and Cochrane library databases was performed. All original studies reporting efficacy and safety of needle‐knife technique for treatment of ZD were included. Pooled event rates across studies were expressed with summative statistics. Main outcomes, such as rates of immediate symptomatic response (ISR), adverse events and recurrence, were extracted, pooled and analyzed. Heterogeneity among studies was assessed using the R statistic. The random effects model was used and results were expressed with forest plots and summative statistics. RESULTS Thirteen studies included 589 patients were enrolled. Pooled event rates for ISR, overall complication, bleeding and perforation were 88% (95% confidence interval [CI] 79–94%), 13% (95% CI 8–22%), 5% (95% CI 3–10%) and 7% (95% CI 4–12%), respectively. The pooled data demonstrated an overall recurrence rate of 14% (95% CI 9–21%). Diverticulum size of at least 4 cm and less than 4 cm demonstrated pooled adverse event rates of 17% (95% CI 10–27%) and 7% (95% CI 2–18%), respectively. When using diverticuloscope as an accessory, pooled ISR and adverse events rates were 84% (95% CI 58–95%) and 10% (95% CI 3–26%), respectively. CONCLUSION Flexible endoscopic procedures using needle‐knife offers a relatively safe and effective treatment of symptomatic ZD, especially for ZD of <4 cm in diameter.