Dr. Merati also pointed to a study that found that the size of the sac is related to the rate of recurrence: Of the 61 endoscopic procedures studied, 77 percent resulted in total symptom resolution, with pouches larger than 3 cm one of the most common risk factors for recurrence.
Explore This IssueFebruary 2012
He said that for medium-sized sacs of 2 to 4 cm, an open or endoscopic procedure might be appropriate, but for all others, open procedure is preferred. He said the shorter procedure time for the endoscopic approach matters much more to the surgeons than to the patients. “I want to help predict, I believe, the swing of the pendulum back towards consideration of the open operation in our armamentarium,” Dr. Merati said.
But Richard Scher, MD, professor and associate chief of otolaryngology-head and neck surgery at Duke University, said an endoscopic procedure is usually the way to go. At Duke, from 2006 to 2011, just 2 percent of 259 endoscopic staple diverticulostomy patients had to have their procedure aborted, and there was a 4 percent recurrence rate, only nine patients out of 252, Dr. Scher said.
Dr. Scher acknowledged that pouches less than 1.5 centimeters in size are not good candidates for endoscopic treatment but said he could find no good data suggesting that endoscopic treatment should not be done on larger pouches. He also said that there was ultimate improvement in dysphagia symptoms in 85 to 92 percent of the patients at Duke over the last five years.
“For most patients, the endoscopic staple approach is the ideal way to deal with these patients initially,” he said, adding that the open approach should be applied “selectively, not in the majority of patients.”
New Hearing Devices
Moisés Arriaga, MD, MBA, FACS, director of otology-neurotology and professor of otolaryngology and neurosurgery at Louisiana State University Health Sciences Center in New Orleans, took the side of implantable hearing devices in the next mini-debate.
Dr. Arriaga, who has participated in clinical trials of several models of middle ear implants, said the approved devices, the Vibrant Soundbridge, the Maxum and the Esteem, have all resulted in better hearing improvement compared to traditional hearing aids. With the Esteem, for example, patients had an overall 21-point improvement in word recognition scores (WRS) compared to their scores with a hearing aid, according to results in the clinical trial leading to its approval.
One of the main reasons for their success is that the canal isn’t blocked with those devices as it is with hearing aids. They also involve direct vibration of the anatomy of the ear.