Evaluation of endoscopic harmonic diverticulostomy

Authors

  • Chad Whited MD,

    1. Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Duke University Hospital, Durham, North Carolina, U.S.A.
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  • Walter T. Lee MD, FACS,

    1. Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Duke University Hospital, Durham, North Carolina, U.S.A.
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  • Richard Scher MD, FACS

    Corresponding author
    1. Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Duke University Hospital, Durham, North Carolina, U.S.A.
    • Duke University Hospital, 200 Trent Dr., 3rd Floor–White Zone, Room 3576, Durham, NC 27707
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  • Presented at American Academy of Otolaryngology-Head and Neck Surgery Foundation Annual Meeting, San Francisco, California, U.S.A., September 14, 2011.

  • Dr. Scher is an educational consultant for Ethicon Endo-Surgery. The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

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.

Study Design:

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.

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