title: Evaluation of endoscopic harmonic diverticulostomy.
abstract: OBJECTIVE
  The purpose of this study is to review a consecutive series of patients with Zenker's diverticulum who were treated with endoscopic diverticulostomy using either the endoscopic stapler (ENDO GIA 30 Autosuture; Covidien, Dublin, Ireland) or Harmonic Ultrasonic Surgical Instrumentation (Ethicon Endo-Surgery, Cincinnati, OH) to evaluate the safety and optimal application of Harmonic technology to the treatment of patients with Zenker's diverticulum.
  
  
  METHODS
  This is a retrospective review at a tertiary academic hospital with institutional review board approval.
  
  
  METHODS
  All patients undergoing endoscopic repair of Zenker's diverticulum between April 1, 2009 and December 1, 2010 at a single institution were studied.
  
  
  RESULTS
  A total of 65 endoscopic diverticulostomies were performed: 24 Harmonic assisted, 41 stapler assisted. Average diverticulum size was 3.46 cm. There were two complications with staple-assisted (pharyngeal leak and recurrence) and six complications with Harmonic-assisted diverticulostomies (two pharyngeal leaks, two chest pains, one recurrence, and one subcutaneous emphysema). There was a statistically significant difference in the complication rates between the staple-assisted (4.88%) and Harmonic-assisted (25%) cohorts (P = .04). There were no complications with diverticula <2 cm.
  
  
  CONCLUSIONS
  Endoscopic Harmonic esophagodiverticulostomy has been reported for the treatment of Zenker's diverticula. However, our data demonstrate a significantly higher complication rate with use of the Harmonic technology compared to the staple-assisted method (P = .04). Additional evaluations are warranted to validate these findings and before Harmonic diverticulostomy can be recommended as treatment for the majority of cases.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Duke University Hospital, Durham, North Carolina 27707, USA.
authors.forename: Chad
authors.initials: C
authors.lastname: Whited
authors.forename: Walter T
authors.initials: WT
authors.lastname: Lee
authors.forename: Richard
authors.initials: R
authors.lastname: Scher
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004724:Endoscopy / Q000379:methods*; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017792:Surgical Stapling / Q000379:methods*; D013718:Tensile Strength; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000295:instrumentation*; D016672:Zenker Diverticulum / Q000175:diagnosis / Q000601:surgery*