title: The safety and efficacy of endoscopic Zenker's diverticulotomy: A cohort study.
abstract: To determine whether the application of laser-assisted techniques for the treatment of Zenker's diverticulum would reduce the failure rate of endoscopic procedures without compromising safety or durability.
  
  
  
  Cohort study with long-term follow-up.
  
  
  
  We performed a single-institution review of 106 consecutive patients in whom endoscopic laser-assisted diverticulotomy (ELD) or endoscopic stapler-assisted diverticulotomy (ESD) was attempted. The Eating Assessment Tool was collected pre- and postoperatively. Long-term follow-up was conducted on average 2.4 years postoperatively.
  
  
  
  The decision to use either ELD or ESD was made intraoperatively. An endoscopic procedure was successfully completed in 103 of 106 patients (97.2%). Eighty-three patients underwent ELD, 20 underwent ESD, and only three required use of an open approach. No serious complications occurred. Postoperatively, there was a significant reduction in dysphagia symptoms. At follow-up, most individuals had dysphagia scores within the normal range (69%) and were eating a regular diet (73%). Fourteen patients (14%) required revision. Compared to historical data from our institution for ESD alone, the addition of ELD resulted in a reduction in the failure rate without an increase in serious complications. Recurrence rates and long-term outcomes were equivalent.
  
  
  
  Through careful patient selection, appropriate workup, and judicious use of techniques, it was possible to perform endoscopic surgery in a majority of patients without serious complications. Both approaches resulted in short- and long-term symptom management with high levels of satisfaction.
  
  
  
  4. Laryngoscope, 126:2705-2710, 2016.
authors.affiliation: School of Medicine, Oregon Health and Science University, Portland, Oregon, U.S.A.
authors.forename: Michelle DeChant
authors.initials: MD
authors.lastname: Barton
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A.
authors.forename: Kara Y
authors.initials: KY
authors.lastname: Detwiller
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Palmer
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Schindler
mesh_terms: D000368:Aged; D015331:Cohort Studies; D004945:Esophagoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation; D017792:Surgical Stapling / Q000009:adverse effects; D016672:Zenker Diverticulum / Q000601:surgery*
keywords: Carbon dioxide laser; Zenker's diverticulum; dysphagia; endoscopy; patient satisfaction; surgical stapler