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Keywords:

  • Zenker diverticulum;
  • esophageal diverticulum;
  • endoscopic diverticulotomy;
  • transcervical diverticulectomy;
  • dysphagia;
  • cricopharyngeal bar;
  • cricopharyngeal myotomy;
  • endoscopic stapling diverticulotomy

Objectives/Hypothesis

To compare long-term symptomatic outcomes between external transcervical (ET) and endoscopic stapling diverticulotomy (ESD) surgeries for Zenker's diverticulum.

Study Design

Retrospective review.

Methods

Patients undergoing surgery for Zenker's diverticulum surgery between 1998 and 2010 with at least 1 year follow-up were telephoned and questioned for dysphagia, choking, regurgitation, and halitosis based on a validated Gastrointestinal Quality-of-Life Index. Symptom degree preoperatively and at phone call was assessed. Patients rated their overall postoperative symptoms as worsened, unchanged, improved, or completely resolved.

Results

A total of 96 patients were eligible for inclusion and 55 were successfully contacted. Of these, 24 underwent ESD and 31 had ET operations. Average follow-up time was significantly longer for the ET group than the ESD group (5.7 vs. 3.1 years respectively, P < 0.01). Gender, age at operation, diverticulum size, and preoperative symptom scores were not statistically different between the two groups. For both techniques, symptom scores showed significant improvement postoperatively (P < 0.01). A greater proportion of patients undergoing ET procedures reported their symptoms to be completely resolved or improved compared with the ESD group (93% vs. 67%, P = 0.015). Patients undergoing ET demonstrated a greater change or improvement in survey score compared to ESD patients (7.23 vs. 3.42, P = 0.014).

Conclusion

Both the ET and ESD surgeries significantly benefit patients, regardless of diverticulum size. Long-term symptomatic outcomes between the two populations indicate that patients with ET procedures attain a greater degree of resolution of preoperative symptoms.

Level of Evidence

4. Laryngoscope, 124:119–125, 2014