Adverse Events after Rigid and Flexible Endoscopic Repair of Zenker's Diverticula: A Systematic Review and Meta-analysis.

Autor: Crawley B; 1 Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Voice and Swallowing Center, Loma Linda, California, USA., Dehom S; 2 School of Nursing, Loma Linda University, Loma Linda, California, USA., Tamares S; 3 School of Medicine and School of Behavioral Sciences, Loma Linda University, Loma Linda, California, USA., Marghalani A; 4 Preventive Dentistry Department, Umm Al-Qura University, Mecca, Saudi Arabia., Ongkasuwan J; 5 Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA., Reder L; 6 Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA., Ivey C; 7 Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine Mount Sinai, New York, New York, USA., Amin M; 8 Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, USA., Fritz M; 9 Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky., Pitman M; 10 Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Columbia University, New York, New York, USA., Tulunay-Ugur O; 11 Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, University of Arkansas, Little Rock, Arkansas., Weissbrod P; 12 San Diego Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, University of California, San Diego, California, USA.
Jazyk: angličtina
Zdroj: Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery [Otolaryngol Head Neck Surg] 2019 Sep; Vol. 161 (3), pp. 388-400. Date of Electronic Publication: 2019 Apr 23.
DOI: 10.1177/0194599819839991
Abstrakt: Objective: To determine adverse events after endoscopic flexible vs endoscopic rigid cricopharyngeal myotomy for treatment of Zenker's diverticulum (ZD).
Data Sources: Systematic review of MEDLINE, Web of Science, CINAHL, Clinicaltrials.gov, and Cochrane Central Register of Controlled Trials for all years according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Additional studies were identified from review citations and a by hand search of manuscripts referencing ZD.
Review Methods: A structured literature search was conducted to identify studies for this systematic review. Methodological Index for Non-randomized Studies (MINORS) criteria were applied to assess study quality. For inclusion, each study had to provide data for at least 10 adult patients who had undergone endoscopic ZD repair reporting clear association with the postprocedure course in each case. Data extracted included all reported adverse events, recurrences, follow-up, and operative times.
Results: In total, 115 studies were included. All but 8 were retrospective case series. Sixty-one reported series of patients after rigid endoscopic stapler repair, 31 after rigid laser repair, and 13 with other rigid endoscopic instruments. Twenty-nine flexible endoscopic studies were included. Mortality, infection, and perforation were not significantly more likely in either the rigid or the flexible group, but bleeding and recurrence were more likely after flexible endoscopic techniques (20% vs <10% and 4% vs 0%, respectively). Dental injury and vocal fold palsy were reported rarely in the rigid endoscopic groups.
Conclusions: Adverse events are rare after endoscopic Zenker's repair. The flexible approach minimizes exposure limitations and can be completed in some patients without general anesthesia. Transoral rigid approaches result in fewer revision surgeries compared with flexible diverticulotomy.
Databáze: MEDLINE
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