Endoscopic Stapling Technique for the Treatment of Zenker Diverticulum vs Standard Open-Neck Technique

Abstract

Background Presently, the 2 most widely used methods for the treatment of Zenker diverticulum are endoscopic stapling of the common party wall between the diverticulum sac and the esophagus and the standard open-neck technique involving diverticulectomy and cricopharyngeal myotomy. Objective To perform an analysis of the hospital charges to determine the economic efficiency of each technique based on our experience at the Mt Sinai Medical Center, New York, NY. Methods A retrospective analysis of 16 patients diagnosed as having Zenker diverticulum was conducted. Eight randomly chosen patients underwent endoscopic stapling with an EndoGIA 35-mm endoscopic stapler (Ethicon Inc, Somerville, NJ), and 8 randomly chosen patients underwent a standard open approach with diverticulectomy. Medical records were reviewed to determine operative time, length of hospital stay, time to oral intake, and postoperative complications. A charge analysis of the operative and postoperative fees was also performed. Statistical analysis between the 2 groups was conducted using analysis of variance and the paired t test. Results The mean ± SD operative time for the endoscopic stapling technique was 25.5 ± 15.78 minutes, which was significantly less (P<.001) than that for the open procedure, 87.6 ± 35.10 minutes. The mean operative charges were roughly equivalent at $5178 for the endoscopic procedure and $5113 for the open procedure. The endoscopic procedure, while shorter in operative time, had the added expense of specialized equipment, specifically the EndoGIA endoscopic stapler. The mean ± SD length of hospital stay for the endoscopic procedure was significantly shorter (P<.001) at 1.3 ± 0.59 days vs 5.2 ± 1.03 days for the open procedure. The inpatient hospital charges for the endoscopic group was also significantly less (P<.001) at a mean of $3589 per stay vs $11 439 for the open group. The mean ± SD time to oral intake was significantly shorter (<.001) at a mean of $3589 per stay vs $11 439 for the open group. The mean ± SD time to oral intake was significantly shorter (P<.001) in the endoscopic group at 0.8 ± 0.26 days vs 5.1 ± 1.25 days for the open group. There were no major complications in either group, and all patients experienced resolution of preoperative symptoms. Conclusions Compared with the standard open technique, the endoscopic stapling technique for the treatment of Zenker diverticulum results in a statistically significant shorter operative time, hospital stay, and time to resume oral feedings. While the charges of the operative procedures were roughly equivalent, the total hospital charges were significantly less for the patients treated endoscopically.