Endoscopic management of Zenker's diverticulum: stapler assisted versus Harmonic Ace.

OBJECTIVES/HYPOTHESIS Endoscopic repair has become the preferred method of treatment for Zenker's diverticuli. The objective of this study is to compare the endoscopic stapling technique with a novel technique using the Harmonic Ace device (Ethicon Endo-Surgery, Inc., Cincinnati, OH). STUDY DESIGN A retrospective chart review. METHODS Medical records of 48 consecutive patients who underwent endoscopic repair of a Zenker's diverticulum were reviewed. Data were gathered for demographics, symptoms, treatment techniques, and outcomes. Analysis was made using standard statistical methods. RESULTS A total of 52 endoscopic procedures were attempted and 50 performed: 28 stapler assisted, 20 Harmonic Ace assisted, and 2 using both techniques. Three procedures were aborted due to anatomic limitations. Forty-four (88%) patients reported complete resolution of their symptoms. Overall, there were six (12%) reported complications. Five (17.9%) complications involved the stapler technique and 1 (5%) using the Harmonic Ace. The difference between these two groups was not significant (P < .38). The average diverticulum size was smaller in the Harmonic Ace group compared to the stapler group (P < .0017). Patients with diverticuli larger than 2 cm were more likely to have postoperative complications than those with smaller ones. CONCLUSIONS Stapler and Harmonic Ace assisted endoscopic repair of Zenker's diverticulum are two safe and effective minimally invasive techniques. Postoperative complications are more likely due to size of the diverticulum and not the device used. The Harmonic Ace used alone or in combination with the stapler may offer additional advantages over conventional open and stapler assisted techniques, addressing size limitations and persistent symptoms.