Complications Following Surgical Management of Zenker Diverticulum: A Comparative Analysis of Endoscopic and Open Approaches

Abstract

Objective: We aim to explore the differences in complication rates in endoscopic versus open transcervical treatment of Zenker diverticulum.

Study design: Retrospective Cohort Study from January 1, 2015 to December 31, 2023.

Setting: Queries of the TriNetX database's United States Collaborative Network.

Methods: A retrospective cohort study was conducted using patients ≥18 years old diagnosed with Zenker diverticulum selected from the TriNetX United States Collaborative Network. Patients undergoing open and endoscopic diverticulectomy between 2015 and 2023 were identified and divided into cohorts and propensity score matched by age, sex, race, ethnicity, and common comorbidities.

Results: Patients that underwent transcervical approach (n = 1033), when compared to patients that underwent endoscopic approach (n = 2182), had higher rates of dysphonia (odds ratio [OR]: 2.44; 95% confidence interval [CI]: 1.47-4.05; P = .001), long-term enteral feeding access (OR: 3.08; 1.74-5.46; P > .001), and infection (OR: 6.65; 3.50-12.65; P > .001). No significant difference was found in rates of esophageal perforation (OR: 1.60; 0.93-2.75; P = .087) or persistent postoperative dysphagia (OR: 1.03; 0.86-1.23, P = .75). There was no significant difference in the number of patients receiving repeat diverticulectomy procedures (OR: 0.83; 0.58-1.19; P = .314).

Conclusion: Based on analysis of a large healthcare database, endoscopic Zenker diverticulectomy is associated with rates of postoperative dysphonia, enteral feeding, and soft tissue infection. Both the open and endoscopic approaches offer relative advantages not captured by this population-level analysis. Thus, judicious selection of patients based on comorbidities and anatomical factors is essential for optimizing outcomes.

Keywords: Zenker Diverticulum; diverticulectomy; endoscopic.