Surgical Outcomes in Zenker Diverticula: A Multicenter, Prospective, Longitudinal Study

Rebecca Howell; Christopher Johnson; Jacqui Allen; Mekibib Altaye; Milan Amin; Semirra Bayan; Peter Belafsky; Brian Cervenka; Brad Desilva; Gregory R Dion; Dale Ekbom; Aaron Friedman; Mark Fritz; John Paul Giliberto; Elizabeth Guardiani; Jan Kasperbauer; Brandon Kim; Brittany N Krekeler; Maggie Kuhn; Paul Kwak; Yue Ma; Lyndsay L Madden; Laura Matrka; Ross Mayerhoff; Mallory McKeon; Cyrus Piraka; Clark A Rosen; Meredith Tabangin; Shaun A Wahab; Keith Wilson; Carter Wright; VyVy N Young; Gregory Postma; Prospective OUtcomes of Cricopharyngeal Hypertonicity (POUCH) Collaborative

doi:10.1002/lary.30753

Surgical Outcomes in Zenker Diverticula: A Multicenter, Prospective, Longitudinal Study

Laryngoscope. 2024 Jan;134(1):97-102. doi: 10.1002/lary.30753. Epub 2023 May 16.

Authors

Rebecca Howell¹, Christopher Johnson², Jacqui Allen³, Mekibib Altaye⁴, Milan Amin⁵, Semirra Bayan⁶, Peter Belafsky⁷, Brian Cervenka¹, Brad Desilva⁸, Gregory R Dion¹, Dale Ekbom⁶, Aaron Friedman¹, Mark Fritz⁹, John Paul Giliberto¹⁰, Elizabeth Guardiani¹¹, Jan Kasperbauer⁶, Brandon Kim⁸, Brittany N Krekeler^{1

12

13}, Maggie Kuhn⁷, Paul Kwak⁵, Yue Ma¹⁴, Lyndsay L Madden¹⁵, Laura Matrka⁸, Ross Mayerhoff¹⁶, Mallory McKeon¹, Cyrus Piraka¹⁷, Clark A Rosen¹⁴, Meredith Tabangin⁴, Shaun A Wahab¹⁸, Keith Wilson¹, Carter Wright¹⁵, VyVy N Young¹⁴, Gregory Postma²; Prospective OUtcomes of Cricopharyngeal Hypertonicity (POUCH) Collaborative

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.
² Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, U.S.A.
³ Department of Surgery, University of Auckland, Auckland, New Zealand.
⁴ Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
⁵ Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York, U.S.A.
⁶ Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.
⁷ Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Davis, California, U.S.A.
⁸ Department of Otolaryngology-Head and Neck Surgery, Ohio State University, Columbus, Ohio, U.S.A.
⁹ Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A.
¹⁰ Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A.
¹¹ Department of Otolaryngology-Head and Neck Surgery, University of Maryland, Baltimore, Maryland, U.S.A.
¹² Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.
¹³ Department of Communication Sciences and Disorders, University of Cincinnati College of Allied Health Sciences, Cincinnati, Ohio, U.S.A.
¹⁴ Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, U.S.A.
¹⁵ Department of Otolaryngology-Head and Neck Surgery, Wake Forest University, Winston-Salem, North Carolina, U.S.A.
¹⁶ Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A.
¹⁷ Department of Gastroenterology/Hepatology, Henry Ford Health System, Detroit, Michigan, U.S.A.
¹⁸ Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.

PMID: 37191092
DOI: 10.1002/lary.30753

Abstract

Objective: To compare improvement in patient-reported outcomes (PROM) in persons undergoing endoscopic and open surgical management of Zenker diverticula (ZD).

Methodology: Prospective, multicenter cohort study of all individuals enrolled in the Prospective OUtcomes of Cricopharyngeus Hypertonicity (POUCH) Collaborative who underwent surgery for ZD. Patient survey, radiography reports, and the 10-item Eating Assessment Tool (EAT-10) pre- and post-procedure were abstracted from a REDCap database, which summarized means, medians, percentages, and frequencies of. Outcome based on operative intervention (endoscopic vs. open) was compared using t-test, Wilcoxon rank sum test or chi-square test, as appropriate.

Results: One hundred and forty-seven persons were prospectively followed. The mean age (SD) of the cohort was 68.7 (11.0). Overall, 66% of patients reported 100% improvement in EAT-10; 81% of patients had greater than 75% improvement; and 88% had greater than 50% improvement. Endoscopic was used for n = 109 patients, and open surgical intervention was used for n = 38. The median [interquartile range, IQR] EAT-10 percent improvement for endoscopic treatment was 93.3% [72, 100], and open was 100% [92.3, 100] (p = 0.05). The incidence of intraoperative complications was 3.7% for endoscopic and 7.9% for open surgical management. The median [IQR] in follow-up was 86 and 97.5 days, respectively.

Conclusion: Both endoscopic and open surgical management of ZD provide significant improvement in patient-reported outcomes. The data suggest that open diverticulectomy may provide a modest advantage in symptomatic improvement compared to endoscopic management. The data suggest that the postoperative complication rate is higher in the open surgical group.

Level of evidence: 3 Laryngoscope, 134:97-102, 2024.

Keywords: CPMD; Zenker; cricopharyngeal bar; cricopharyngeal dysfunction; cricopharyngeus muscle dysfunction; hypopharyngeal diverticulum; pharyngoesophageal dysphagia.

Publication types

Clinical Study
Comparative Study
Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Cohort Studies
Esophagoscopy
Humans
Longitudinal Studies
Middle Aged
Prospective Studies
Retrospective Studies
Treatment Outcome
Zenker Diverticulum* / surgery

Grants and funding

2019 Research Career Development Award (RH)/American Laryngological, Rhinological and Otological Society