title: The endoscopic management of Zenker diverticulum: CO2 laser versus endoscopic stapling.
abstract: OBJECTIVE
  The purpose of this project was to analyze the endoscopic management of Zenker diverticulum (ZD) using both the CO2 laser and endoscopic stapling techniques. This study compares the two techniques in terms of diverticulum size, onset to oral intake, hospital stay, resolution of symptoms (dysphagia and regurgitation), and complications.
  
  
  METHODS
  A retrospective consecutive case series was performed at an academic medical center.
  
  
  METHODS
  Forty patients underwent an attempted endoscopic resection of the ZD using either the CO2 laser or the endoscopic stapling technique. The two techniques were compared on a variety of parameters, including diverticulum size, hospital stay, onset to oral intake, resolution of symptoms, and complications. Symptom scores were obtained before and after surgery with a patient self-reported scoring report (scale 0-3 for both dysphagia and regurgitation with 0 indicating asymptomatic and 3 severe symptoms).
  
  
  RESULTS
  Forty patients underwent an attempted endoscopic management of ZD. Five patients (12.5%) failed endoscopic exposure (four converted to open, one observed). Sixteen patients underwent CO2 laser management and 19 underwent endoscopic stapling. The mean diverticulum size (3.8 cm CO2 laser versus 4.4 cm stapling) was not significantly different for the two groups. Both groups demonstrated a significant decrease in preoperative versus postoperative dysphagia and regurgitation symptoms scores, respectively, CO2 laser dysphagia scores decreasing from 2.75 to 1.38 and the regurgitation score dropping from 1.51 to 0.68, whereas endoscopic stapling dysphagia score decreased from 2.74 to 1.21 and the regurgitation score dropped from 1.37 to 0.53. Overall, 86% of patients demonstrated an onset of liquid intake on postoperative day 1 and the average length of stay was 3.4 days in the CO2 laser group and 1.5 days in the endoscopic stapling (P < .0015). Complications included dental trauma in four patients (two CO2 laser and two stapling) and subcutaneous air in three patients (all three CO2 laser). There were no cases of mediastinitis, recurrent laryngeal nerve injury, fistula, or perioperative death.
  
  
  CONCLUSIONS
  The endoscopic management of ZD is a safe and effective technique. The endoscopic stapling technique appears to have an improved efficacy and safety when compared with the CO2 laser technique. The two techniques are compared and contrasted.
authors.affiliation: Department of Otolaryngology-Head Neck Surgery, University of Texas Health Science Center, San Antonio, Texas, USA. millerfr@uthscsa.edu
authors.forename: Frank R
authors.initials: FR
authors.lastname: Miller
authors.forename: Jess
authors.initials: J
authors.lastname: Bartley
authors.forename: Randal A
authors.initials: RA
authors.lastname: Otto
mesh_terms: D000368:Aged; D002245:Carbon Dioxide; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D011183:Postoperative Complications; D018709:Statistics, Nonparametric; D017792:Surgical Stapling; D016896:Treatment Outcome; D016672:Zenker Diverticulum / Q000601:surgery*
chemical_list: D002245:Carbon Dioxide