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Ishaq S, Hassan C, Antonello A, Tanner K, Bellisario C, Battaglia G, Anderloni A, Correale L, Sharma P, Baron TH, Repici A. Flexible endoscopic treatment for Zenker's diverticulum: a systematic review and meta-analysis. Gastrointest Endosc 2016; 83:1076-1089.e5. [PMID: 26802196 DOI: 10.1016/j.gie.2016.01.039] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 01/13/2016] [Indexed: 12/11/2022]
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.
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Affiliation(s)
- Sauid Ishaq
- Department of Gastroenterology, Russells Hall Hospital, Birmingham City University, Birmingham, UK; Department of Medicine, St. George's University, St. George, Grenada
| | - Cesare Hassan
- Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | | | - Keeley Tanner
- Department of Gastroenterology, Russells Hall Hospital, Birmingham City University, Birmingham, UK
| | - Cristina Bellisario
- Department of Cancer Screening, Centre for Epidemiology and Prevention in Oncology (CPO), University Hospital "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Giorgio Battaglia
- Digestive Endoscopy Unit, Veneto Institute of Oncology, Padua, Italy
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan, Italy
| | - Loredana Correale
- Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Prateek Sharma
- Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas, Kansas City, Missouri, USA
| | - Todd H Baron
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Alessandro Repici
- 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
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