Carbon dioxide laser versus stapler-assisted endoscopic Zenker's diverticulotomy: A systematic review and meta-analysis

To evaluate outcomes following endoscopic management of Zenker's diverticula using a carbon dioxide laser (CO2) or stapler-assisted technique, a systematic review and meta-analysis were conducted. Seven retrospective, uncontrolled case series including 391 procedures met selection criteria. No higher quality studies were identified. Outcomes favoring the stapler technique included a shorter duration of nil per os (NPO) status (2 studies), length of hospitalization (LOH, 2 studies), and fewer postoperative fevers and abnormal chest x-rays (1 study). Outcomes favoring the CO2 technique included greater improvement in postoperative dysphagia and regurgitation scores (2 studies) and a lower revision rate (1 study). Meta-analysis demonstrated increased nondental complications in the CO2 group (odds ratio 3.81; 95% confidence interval, 1.37-10.59; P =.01) but no difference in duration of NPO (P =.06), LOH (P =.07), overall complications (P =.08), dental complications (P =.57), major complications (P =.38), or revision surgery (P =.82). Implications are limited by the quality of studies identified.