Techniques and efficacy of flexible endoscopic therapy of Zenker’s diverticulum

Table 1 Published cases for flexible endoscopic therapy of Zenker’s diverticulum

Ref.	Total patients (n = 678)	Age (range)	Device for myotomy	Assist device	Pre-procedure dysphagia score	Post-procedure dysphagia score	Clinical symptom resolution rate	Adverse events	Recurrences	Followup (range)
Mulder et al[12]	20	Mean 82 (41-100)	FC	None	NA	NA	85%	0%	0	Mean 7 (1-18)
Ishioka et al[13]	42	Mean 68 (46-102)	NK	None	NA	NA	93%	5%	7	Mean 38 (12-96)
Hashiba et al[14]	47	(58-81)	NK	None	NA	0 or 1	96%	14.9%	0	(0-12)
Mulder et al[15]	125	Median 77 (41-100)	APC	None	NA	NA	100%	20%	NA	NA
Sakai et al[16]	10	(67-87)	NK	Cap	1.8	0	100%	0%	0	(2-12)
Evrard et al[17]	31	Median 78	NK	DS			93%	13%	9	Median 12.5
Costamagna et al[18]	28	Median 66 (47-86)	NK	Cap	NA	NA	43%	32%	4	Median 36(9-60)
Costamagna et al[18]	11	Median 70 (63-84)	NK	DS	NA	NA	91%	0%	1	Median 6.5(3-15)
Rabenstein et al[19]	41	Mean 73	APC	Cap	NA	NA	95%	19.5%	5	Mean 16
Christiaens et al[10]	21	Median 77.5 (52-89)	FC	Cap	1.5	0	100%	3%	2	Median 22.4
Volgelsang et al[20]	31	Median 69 (52-92)	NK	Cap	NA	NA	100%	23%	10	Mean 26
Manner et al[21]	8	Mean 66	APC	Cap	NA	NA	NA	37.5%	NA	NA
Tang et al[22]	6	Mean 71 (48-91)	NK	Endo Clips	NA	NA	100%	0%	0	NA
Al-Kadi et al[23]	18	Mean 80 (68-91)	NK	None	(2-4)	NA	87.5%	5.5%	NA	Mean 27.5
Case et al[24]	22	Median 85	NK	None	NA	NA	100%	32%	4	Mean 12.7
Repici et al[25]	32	Mean 74.8 (58-92)	HK	Cap	2.96	0.62	NA	6.25%	3	Mean 23.9(12-48)
Hondo et al[26]	5	Median 69.6 (59-83)	HS	DS	2	0.20	NA	0%	0	Mean 1
Huberty et al[27]	150	Median 73 (42-94)	NK	DS	1.88	0.34	90.3%	2.2%	31	Median 43(13-121)
Ramchandani et al[28]	3	Mean 79	SB-K	DS	NA	NA	100%	0%	0	NA
Manno et al[29]	19	Median 74 (46-84)	IT-K	DS	NA	NA	100%	0%	2	Median 27
Perbtani(current study)	8	72.4	NK	None	2.6	0.4	100%	0%	2	Mean 5.8(1-17)

NK: Needle knife; IT-K: Insulated tip knife; SB-K: Stag beetle knife; HK: Hook knife; HS: Harmonic scalpel; FC: Forceps coagulation; APC: Argon plasma coagulation; DS: Diverticuloscope; NA: Not available.

Table 2 Modes of sedation used n (%)

Sedation type	Patients (n = 678)
Conscious sedation	352 (52)
Monitored anesthesia care	60 (9)
General anesthesia	77 (11)
Not reported	189 (28)

Table 3 Devices used for cricopharyngeus myotomy n (%)

Device for myotomy	Patients (n = 678)
Needle knife	404 (59.6)
APC	174 (25.7)
Forceps coagulation	41 (6)
Hook knife	32 (4.7)
Insulated tip knife	19 (2.9)
Harmonic scalpel	5 (0.7)
Stag beetle knife	3 (0.4)

Table 4 Published adverse events after flexible endoscopic therapy of Zenker’s diverticulum n (%)

Adverse events	80/678 (11.8%)
Micro perforations	52/678 (7.7)
Cervical emphysema	1
Mediastinal emphysema	5
Subcutaneous emphysema	25
Unspecified	21
Macro perforations	4/678 (0.6)
Bleeding	9/678 (1.3)
Infection	12/678 (1.8)
Fever	10
Pneumonia	1
Neck abscess	1
Death	1/678 (0.1)
Adverse events, not otherwise specified	2/678 (0.3)