Harmonic scalpel for endoscopic treatment of Zenker's diverticulum: a critical review of the literature

Endoscopic staple-assisted diverticulostomy (ESD) is generally accepted as the preferred treatment option for patients with Zenker’s diverticulum (ZD). However, anatomical factors may preclude the use of ESD in certain patients. In recent years, the harmonicscalpel has been introduced as an alternative device for endoscopic management of ZD, which may be useful in certain cases where diverticulum anatomy prevents the use of ESD. This review aims to assess the efficacy and safety of endoscopic ZD-repair using the harmonic-scalpel, including comparative analysis of the harmonic and staple assisted approaches in terms of their surgical outcomes. Conclusion: Most studies support the use of the harmonic-scalpel as a safe and effective treatment option for ZD. Although the harmonic-assisted technique may not replace ESD as the initial treatment of choice for ZD, it may serve as a useful adjunct to treatment in selected cases. However, given the low quality of evidence and concerns regarding treatment complications, large prospective randomised trials comparing the harmonic and staple-assisted techniques are necessary in order to determine whether the harmonic-scalpel is truly a viable option for endoscopic ZD-management.