Surgical Nonresponders in Zenker Diverticulum and Lower Esophageal Pathology (POUCH Collaborative)

Johnathan Brown¹, Nicole McCoy¹, Jacqui Allen², Mekibib Altaye³, Milan Amin⁴, Semirra Bayan⁵, Peter Belafsky⁶, Brad DeSilva⁷, Greg Dion¹, Dale Ekbom⁵, Aaron Friedman¹, Mark Fritz⁸, John Paul Giliberto⁹, Elizabeth Guardiani¹⁰, Christopher Johnson¹¹, Jan Kasperbauer⁵, Brandon Kim⁷, Brittany N Krekeler^{1

12

13}, Maggie Kuhn⁶, Paul Kwak⁴, Yue Ma¹⁴, Lyndsay L Madden¹⁵, Laura Matrka⁷, Ross Mayerhoff¹⁶, Cyrus Piraka¹⁷, Clark A Rosen¹⁴, Meredith Tabangin³, Shaun Wahab¹⁸, Keith Wilson¹, Carter Wright¹⁵, VyVy N Young¹⁴, Gregory Postma¹¹, Rebecca J Howell¹

Affiliations

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

PMID: 38979706
DOI: 10.1002/lary.31619

Multicenter Study

Surgical Nonresponders in Zenker Diverticulum and Lower Esophageal Pathology (POUCH Collaborative)

Johnathan Brown et al. Laryngoscope. 2024 Dec.

. 2024 Dec;134(12):4897-4902.

doi: 10.1002/lary.31619. Epub 2024 Jul 9.

Authors

Affiliations

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

PMID: 38979706
DOI: 10.1002/lary.31619

Abstract

Objective: To identify characteristics of patients who have poor improvement in symptoms following surgical management of Zenker Diverticulum (ZD).

Methods: Prospective, multicenter cohort study of all individuals enrolled in the Prospective OUtcomes of Cricopharyngeus Hypertonicity (POUCH) Collaborative who underwent surgical repair of ZD between August 2017 and January 2024. Patient demographics, esophagrams, and the 10-item Eating Assessment Tool (EAT-10) pre- and post-procedure were obtained from a REDCap database. t-tests, Wilcoxon rank sum tests, Chi-square or Fisher's exact tests were used to compare the characteristics. Patients with <50% improvement in their EAT-10 scores were deemed surgical nonresponders (SNRs). Those with ≥50% improvement in their EAT-10 scores were deemed surgical responders (SRs).

Results: A total of 184 patients were prospectively followed after undergoing either open or endoscopic surgical management. Twenty-two patients (12%) were deemed SNRs. Preoperative presence of a hiatal hernia was statistically significant characteristic between the SNRs (63.6%) and SRs (32.1%) (p = 0.004). Size of the ZD and history of previous ZD surgery was not a significant characteristic. The length of stay and complication rate were not statistically different between the groups.

Conclusion: Coexistent esophageal pathology may lead to poor symptomatic improvement following ZD surgery. Preoperative workup of other esophageal disorders is recommended to detect likely SNRs. For SNRs, further esophageal workup may be necessary to evaluate for other esophageal causes related to poor symptomatic improvement following ZD surgery.

Level of evidence: 3 Laryngoscope, 134:4897-4902, 2024.

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

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References

BIBLIOGRAPHY

1. Cook IJ, Gabb M, Panagopoulos V, et al. Pharyngeal (Zenker's) diverticulum is a disorder of upper esophageal sphincter opening. Gastroenterology. 1992;103(4):1229‐1235.
1. Kasle DA, Torabi SJ, Boey H, Sasaki CT. Hypopharyngeal diverticulum: toward a unified understanding of its etiopathogenesis. Dysphagia. 2019;34(5):713‐715.
1. Howell R, Johnson C, Allen J, et al. Surgical outcomes in zenker diverticula: a multicenter, prospective, longitudinal study. Laryngoscope. 2024;134(1):97‐102.
1. Belafsky PC, Mouadeb DA, Rees CJ, et al. Validity and reliability of the eating assessment tool (EAT‐10). Ann Otol Rhinol Laryngol. 2008;117(12):919‐924.
1. Howell RJ, Ekbom D, Kasperbauer J, et al. Cricopharyngeus muscle dysfunction and hypopharyngeal diverticula (e.g., Zenker): a multicenter study. Laryngoscope. 2023;133(6):1349‐1355.

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American Laryngological, Rhinological and Otological Society, 2019 Research Career Development Award

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Surgical Nonresponders in Zenker Diverticulum and Lower Esophageal Pathology (POUCH Collaborative)

Affiliations

Surgical Nonresponders in Zenker Diverticulum and Lower Esophageal Pathology (POUCH Collaborative)

Authors

Affiliations

Abstract

References

BIBLIOGRAPHY

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Research Materials