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.
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.