P0844 - Effectiveness and Safety of Stag Beetle Knife in Management of Zenker’s Diverticulum: A Systematic Review and Meta-Analysis

Dushyant Singh. Dahiya, MD¹, Smit Deliwala, MD², Saurabh Chandan, MD³, Daryl Ramai, MD⁴, Lena Kassab, MD, MBA⁵, Antonio Facciorusso, MD⁶, Gursimran S. Kochhar, MD^7
1University of Kansas School of Medicine, Kansas City, KS; ²Emory University School of Medicine, Atlanta, GA; ³Creighton University School of Medicine, Omaha, NE; ⁴University of Utah School of Medicine, Salt Lake City, UT; ⁵Mayo Clinic, Rochester, MN; ⁶University of Foggia, Foggia, Italy, Neptune, NJ; ⁷Allegheny Health Network, Pittsburgh, PA

Introduction: Stag Beetle Knife (SB Knife), a scissor-shaped device with two insulated monopolar blades, is increasingly being utilized for Zenker’s Diverticulectomy. We aimed to assess the effectiveness and safety of the SB Knife for the management of Zenker’s Diverticulum (ZD).

Methods: Ovid EBM reviews, Ovid Embase, Ovid Medline, ClinicalTrials.gov, Scopus, and Web of Science were searched through February 2023 to identify all studies that reported effectiveness and safety outcomes for the utilization of SB knife for Zenker’s Diverticulectomy. Pooled proportions (PP) and 95% Confidence Intervals (CI) were calculated using the random-effects model. Heterogeneity was evaluated using I² statistics.

Results: A total of 7 studies with 268 patients were included in the final analysis. Dysphagia and regurgitation were the most common clinical symptoms. The mean size of the ZD was 2.8 ± 0.7 cm, the mean number of treatment sessions per patient was 1.11 ± 0.08, and 28 (of 148) patients had undergone previous treatments. Overall, the mean follow-up time after the procedure was 15.7 ± 13.8 months.



The PP of technical success, defined as successful completion of the procedure, was 98% (95% CI: 92.3–99.5; I²0) with a mean procedure duration of 26.2 ± 8.3 minutes. The PP of clinical response, defined as symptomatic improvement after the index procedure, was 87.9% (95% CI: 81.6–92.3; I²19). The PP of relapse of symptoms after index procedure was 13.5% (95% CI: 9.6–18.6; I²2).



At final follow-up, the PP of clinical remission, defined as complete resolution of symptoms post-intervention(s), was 96.2% (95% CI: 91–98.4; I²30.6) while the PP of procedure failure (persistent symptoms) was 3.6% (95% CI: 1.6–8.1; I²0).



No severe adverse events (AEs) were noted while using the SB Knife. However, the PP of intraprocedural and postprocedural AEs were 13.2% (95% CI: 9.6–17.8; I²0) and 9.3% (95% CI: 5.7–14.9; I²< 20.9), respectively. Minor bleeding (10.1%) and minor perforation (3.6%) were the most common intraprocedural and postprocedural AEs, respectively.

Discussion: Our analysis demonstrated that Zenker’s Diverticulectomy with an SB Knife can be performed efficiently in about 30 minutes with a high degree of clinical success and technical ease in a majority of patients. Furthermore, the utilization of SB knife was associated with low rates of intraprocedural and postprocedural AEs, highlighting its excellent safety profile.


Disclosures:


Dushyant Singh. Dahiya, MD¹, Smit Deliwala, MD², Saurabh Chandan, MD³, Daryl Ramai, MD⁴, Lena Kassab, MD, MBA⁵, Antonio Facciorusso, MD⁶, Gursimran S. Kochhar, MD⁷. P0844 - Effectiveness and Safety of Stag Beetle Knife in Management of Zenker’s Diverticulum: A Systematic Review and Meta-Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.