Sauid Ishaq1, Cesare Hassan2, Alessandro Antonello3, Keeley Tanner4, Cristina Bellisario5, Giorgio Battaglia3, Andrea Anderloni6, Loredana Correale2, Prateek Sharma7, Todd H Baron8, Alessandro Repici9. 1. Department of Gastroenterology, Russells Hall Hospital, Birmingham City University, Birmingham, UK; Department of Medicine, St. George's University, St. George, Grenada. 2. Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy. 3. Digestive Endoscopy Unit, Veneto Institute of Oncology, Padua, Italy. 4. Department of Gastroenterology, Russells Hall Hospital, Birmingham City University, Birmingham, UK. 5. Department of Cancer Screening, Centre for Epidemiology and Prevention in Oncology (CPO), University Hospital "Città della Salute e della Scienza di Torino", Turin, Italy. 6. Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan, Italy. 7. Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas, Kansas City, Missouri, USA. 8. Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA. 9. Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan, Italy; Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas, Kansas City, Missouri, USA.
Abstract
BACKGROUND AND AIMS: Flexible endoscopic septum division (FESD) is a rapidly evolving technique for the treatment of Zenker's diverticulum (ZD). The aim was to perform a systematic review and meta-analysis of the literature focusing on FESD for ZD, including an in-depth evaluation of its efficacy, safety, and limitations. METHODS: A comprehensive literature search was completed to identify papers that examined the efficacy and safety of FESD for ZD. Demographic, clinical, and technical information was retrieved. Main outcomes were extracted, pooled, and analyzed. Heterogeneity among studies was assessed using the I(2) statistic. A random effect model was used as the pooling method in cases of high heterogeneity; otherwise the fixed effect model was applied. Meta-regression was also performed. Main outcomes such as rates of success, adverse events, and recurrences were evaluated. RESULTS: Twenty studies with a total of 813 patients were selected. The pooled success, adverse events, and recurrence rates were 91% (95% confidence interval [CI], 86%-95%; I(2) = 69.5%), 11.3% (95% CI, 8%-16%; I(2) = 64%), and 11% (95% CI, 8%-15%; I(2) = 38.4%), respectively. Substantial heterogeneity across studies was found. However, for success rates, excluding 3 studies reduced heterogeneity to non-significant rates [I(2) = 25.6%; P = .154]. Adverse event rates decreased with larger samples (coefficient, -0.0123; 95% CI, -0.03 to -0.003; P = .017), whereas recurrence rates increased (coefficient, 0.006; 95% CI, -0.0010 to 0.0125; P = .093). Year of publication was negatively associated with success rate, whereas the opposite pattern was found for recurrence rates. CONCLUSIONS: FESD is a feasible, safe, and effective treatment for symptomatic ZD, with low adverse event and recurrence rates.
BACKGROUND AND AIMS: Flexible endoscopic septum division (FESD) is a rapidly evolving technique for the treatment of Zenker's diverticulum (ZD). The aim was to perform a systematic review and meta-analysis of the literature focusing on FESD for ZD, including an in-depth evaluation of its efficacy, safety, and limitations. METHODS: A comprehensive literature search was completed to identify papers that examined the efficacy and safety of FESD for ZD. Demographic, clinical, and technical information was retrieved. Main outcomes were extracted, pooled, and analyzed. Heterogeneity among studies was assessed using the I(2) statistic. A random effect model was used as the pooling method in cases of high heterogeneity; otherwise the fixed effect model was applied. Meta-regression was also performed. Main outcomes such as rates of success, adverse events, and recurrences were evaluated. RESULTS: Twenty studies with a total of 813 patients were selected. The pooled success, adverse events, and recurrence rates were 91% (95% confidence interval [CI], 86%-95%; I(2) = 69.5%), 11.3% (95% CI, 8%-16%; I(2) = 64%), and 11% (95% CI, 8%-15%; I(2) = 38.4%), respectively. Substantial heterogeneity across studies was found. However, for success rates, excluding 3 studies reduced heterogeneity to non-significant rates [I(2) = 25.6%; P = .154]. Adverse event rates decreased with larger samples (coefficient, -0.0123; 95% CI, -0.03 to -0.003; P = .017), whereas recurrence rates increased (coefficient, 0.006; 95% CI, -0.0010 to 0.0125; P = .093). Year of publication was negatively associated with success rate, whereas the opposite pattern was found for recurrence rates. CONCLUSIONS: FESD is a feasible, safe, and effective treatment for symptomatic ZD, with low adverse event and recurrence rates.
Authors: Daniel T Friedrich; M O Scheithauer; J Greve; N Rotter; J Doescher; T K Hoffmann; P J Schuler Journal: Eur Arch Otorhinolaryngol Date: 2017-02-24 Impact factor: 2.503
Authors: Michael J Klingler; Joshua P Landreneau; Andrew T Strong; Juan S Barajas-Gamboa; Christine Tat; Chao Tu; Alisan Fathalizadeh; Matthew Kroh; John Rodriguez; Madhusudhan R Sanaka; Jeffrey Ponsky Journal: Surg Endosc Date: 2020-08-06 Impact factor: 4.584