Endoscopic needle‐knife treatment for symptomatic esophageal Zenker’s diverticulum: A meta‐analysis and systematic review
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...
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Published in | Journal of digestive diseases Vol. 19; no. 4; pp. 204 - 214 |
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Main Authors | , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Melbourne
Wiley Publishing Asia Pty Ltd
01.04.2018
Wiley Subscription Services, Inc |
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Abstract | 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. |
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AbstractList | OBJECTIVEThe aim of this study was to assess the efficacy and safety following endoscopic management of Zenker's diverticulum (ZD) using a needle-knife technique.METHODSA 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.RESULTSThirteen 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.CONCLUSIONFlexible endoscopic procedures using needle-knife offers a relatively safe and effective treatment of symptomatic ZD, especially for ZD of <4 cm in diameter. 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. 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. 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. 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. Flexible endoscopic procedures using needle-knife offers a relatively safe and effective treatment of symptomatic ZD, especially for ZD of <4 cm in diameter. |
Author | Wang, Xiao Ying Liang, Shu Wen Spandorfer, Robert M. Yang, Yong Tao Cai, Qiang Zhong, Chang Qing Christofaro, Sarah Qu, Chang Min Chen, Yan Li, Lian Yong |
Author_xml | – sequence: 1 givenname: Lian Yong orcidid: 0000-0002-0852-7005 surname: Li fullname: Li, Lian Yong organization: The 306th Hospital of PLA – sequence: 2 givenname: Yong Tao surname: Yang fullname: Yang, Yong Tao organization: The 306th Hospital of PLA – sequence: 3 givenname: Chang Min surname: Qu fullname: Qu, Chang Min organization: The 306th Hospital of PLA – sequence: 4 givenname: Shu Wen surname: Liang fullname: Liang, Shu Wen organization: The 306th Hospital of PLA – sequence: 5 givenname: Chang Qing surname: Zhong fullname: Zhong, Chang Qing organization: The 306th Hospital of PLA – sequence: 6 givenname: Xiao Ying surname: Wang fullname: Wang, Xiao Ying organization: The 306th Hospital of PLA – sequence: 7 givenname: Yan surname: Chen fullname: Chen, Yan organization: The 306th Hospital of PLA – sequence: 8 givenname: Robert M. surname: Spandorfer fullname: Spandorfer, Robert M. organization: Emory University – sequence: 9 givenname: Sarah surname: Christofaro fullname: Christofaro, Sarah organization: Emory University – sequence: 10 givenname: Qiang surname: Cai fullname: Cai, Qiang email: qcai@emory.edu organization: Emory University |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/29675866$$D View this record in MEDLINE/PubMed |
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Cites_doi | 10.1016/j.otohns.2008.10.035 10.1055/s-2006-944657 10.1055/s-0042-106203 10.1007/s00464-012-2261-0 10.1016/j.gie.2012.12.008 10.1016/j.otorri.2009.05.001 10.1067/mge.2003.311 10.1177/000348949910800817 10.1046/j.1365-2168.1996.02307.x 10.4065/mcp.2009.0663 10.1007/s00464-015-4445-x 10.1111/j.1442-2050.2010.01143.x 10.3109/00016489609137857 10.1002/bjs.18003815002 10.1016/j.gie.2016.01.039 10.1016/j.jamcollsurg.2010.04.011 10.1016/S0016-5107(99)70452-9 10.1159/000258354 10.1055/s-2007-966140 10.3748/wjg.v13.i18.2586 10.1016/j.gie.2016.06.019 10.1016/j.gie.2015.08.044 10.1055/s-2007-1005736 10.1016/j.gie.2011.03.137 10.1067/mge.2001.119606 |
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Copyright | 2018 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd 2018 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd. |
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Keywords | meta-analysis endoscopic treatment Zenker’s diverticulum systematic review needle-knife |
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The aim of this study was to assess the efficacy and safety following endoscopic management of Zenker’s diverticulum (ZD) using a needle‐knife... 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. A... OBJECTIVEThe aim of this study was to assess the efficacy and safety following endoscopic management of Zenker’s diverticulum (ZD) using a needle‐knife... OBJECTIVEThe aim of this study was to assess the efficacy and safety following endoscopic management of Zenker's diverticulum (ZD) using a needle-knife... |
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SubjectTerms | Diverticulum endoscopic treatment Endoscopy Esophagus Meta-analysis needle‐knife Statistical analysis systematic review Zenker’s diverticulum |
Title | Endoscopic needle‐knife treatment for symptomatic esophageal Zenker’s diverticulum: A meta‐analysis and systematic review |
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