title: Flexible endoscopic treatment for Zenker's diverticulum: a systematic review and meta-analysis.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Gastroenterology, Russells Hall Hospital, Birmingham City University, Birmingham, UK; Department of Medicine, St. George's University, St. George, Grenada.
authors.forename: Sauid
authors.initials: S
authors.lastname: Ishaq
authors.affiliation: Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
authors.affiliation: Digestive Endoscopy Unit, Veneto Institute of Oncology, Padua, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Antonello
authors.affiliation: Department of Gastroenterology, Russells Hall Hospital, Birmingham City University, Birmingham, UK.
authors.forename: Keeley
authors.initials: K
authors.lastname: Tanner
authors.affiliation: Department of Cancer Screening, Centre for Epidemiology and Prevention in Oncology (CPO), University Hospital "Città della Salute e della Scienza di Torino", Turin, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Bellisario
authors.affiliation: Digestive Endoscopy Unit, Veneto Institute of Oncology, Padua, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Battaglia
authors.affiliation: Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Anderloni
authors.affiliation: Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy.
authors.forename: Loredana
authors.initials: L
authors.lastname: Correale
authors.affiliation: Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas, Kansas City, Missouri, USA.
authors.forename: Prateek
authors.initials: P
authors.lastname: Sharma
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Todd H
authors.initials: TH
authors.lastname: Baron
authors.affiliation: 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.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Repici
mesh_terms: D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery*; D020701:Esophagoscopes; D004945:Esophagoscopy / Q000379:methods*; D006801:Humans; D010609:Pharyngeal Muscles / Q000601:surgery*; D016896:Treatment Outcome; D016672:Zenker Diverticulum / Q000150:complications / Q000601:surgery*