Flexible endoscopic treatment for Zenker's diverticulum: A systematic review and meta-analysis

Sauid Ishaq, Cesare Hassan, Alessandro Antonello, Keeley Tanner, Cristina Bellisario, Giorgio Battaglia, Andrea Anderloni, Loredana Correale, Prateek Sharma, Todd H. Baron, Alessandro Repici

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40 Citations (Scopus)

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 I2 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%; I2 = 69.5%), 11.3% (95% CI, 8%-16%; I2 = 64%), and 11% (95% CI, 8%-15%; I2 = 38.4%), respectively. Substantial heterogeneity across studies was found. However, for success rates, excluding 3 studies reduced heterogeneity to non-significant rates [I2 = 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.

Original languageEnglish
JournalGastrointestinal Endoscopy
DOIs
Publication statusAccepted/In press - Jul 13 2015

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Zenker Diverticulum
Meta-Analysis
Confidence Intervals
Recurrence
Therapeutics
Safety
Publications
Demography

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

Cite this

Flexible endoscopic treatment for Zenker's diverticulum : A systematic review and meta-analysis. / Ishaq, Sauid; Hassan, Cesare; Antonello, Alessandro; Tanner, Keeley; Bellisario, Cristina; Battaglia, Giorgio; Anderloni, Andrea; Correale, Loredana; Sharma, Prateek; Baron, Todd H.; Repici, Alessandro.

In: Gastrointestinal Endoscopy, 13.07.2015.

Research output: Contribution to journalArticle

Ishaq, Sauid ; Hassan, Cesare ; Antonello, Alessandro ; Tanner, Keeley ; Bellisario, Cristina ; Battaglia, Giorgio ; Anderloni, Andrea ; Correale, Loredana ; Sharma, Prateek ; Baron, Todd H. ; Repici, Alessandro. / Flexible endoscopic treatment for Zenker's diverticulum : A systematic review and meta-analysis. In: Gastrointestinal Endoscopy. 2015.
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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 I2 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{\%}; I2 = 69.5{\%}), 11.3{\%} (95{\%} CI, 8{\%}-16{\%}; I2 = 64{\%}), and 11{\%} (95{\%} CI, 8{\%}-15{\%}; I2 = 38.4{\%}), respectively. Substantial heterogeneity across studies was found. However, for success rates, excluding 3 studies reduced heterogeneity to non-significant rates [I2 = 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.",
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AU - Ishaq, Sauid

AU - Hassan, Cesare

AU - Antonello, Alessandro

AU - Tanner, Keeley

AU - Bellisario, Cristina

AU - Battaglia, Giorgio

AU - Anderloni, Andrea

AU - Correale, Loredana

AU - Sharma, Prateek

AU - Baron, Todd H.

AU - Repici, Alessandro

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N2 - 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 I2 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%; I2 = 69.5%), 11.3% (95% CI, 8%-16%; I2 = 64%), and 11% (95% CI, 8%-15%; I2 = 38.4%), respectively. Substantial heterogeneity across studies was found. However, for success rates, excluding 3 studies reduced heterogeneity to non-significant rates [I2 = 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.

AB - 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 I2 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%; I2 = 69.5%), 11.3% (95% CI, 8%-16%; I2 = 64%), and 11% (95% CI, 8%-15%; I2 = 38.4%), respectively. Substantial heterogeneity across studies was found. However, for success rates, excluding 3 studies reduced heterogeneity to non-significant rates [I2 = 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.

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