Normal fluoroscopic appearance status post-successful endoscopic Zenker diverticulotomy

Area of Science:

• Otolaryngology
• Gastroenterology
• Radiology

Background:

• Endoscopic Zenker diverticulotomy (EZD) is a primary treatment for Zenker diverticulum (ZD).
• Interpreting postoperative videofluoroscopic swallow study (VFSS) findings after EZD can be challenging as the diverticulum is not excised.
• Establishing normal postoperative VFSS findings is crucial for assessing treatment success.

Purpose of the Study:

• To describe the normal videofluoroscopic swallow study (VFSS) findings following successful endoscopic Zenker diverticulotomy (EZD).
• To provide a benchmark for interpreting postoperative swallow studies in patients treated for Zenker diverticulum.

Main Methods:

• Retrospective chart review of patients with ZD treated between October 2011 and May 2014.
• Outcome measures included recidivistic diverticulum size, Eating Assessment Tool-10 (EAT-10) scores, penetration aspiration scale, pharyngeal constriction ratio (PCR), and pharyngoesophageal segment (PES) opening.

Main Results:

• Twenty patients met inclusion criteria. Mean EAT-10 scores decreased significantly (72.1%), and diverticulum size reduced by approximately 50%.
• Pharyngeal constriction ratio (PCR) improved by 33.6%, indicating better pharyngeal function.
• Pharyngoesophageal segment (PES) opening increased significantly in both lateral (61.6%) and anteroposterior (40.0%) views.

Conclusions:

• Post-successful EZD, VFSS demonstrates significant reduction in diverticulum size and improved swallowing mechanics.
• These findings establish a framework for expected fluoroscopic outcomes after successful Zenker diverticulotomy.
• The study provides valuable reference data for clinicians evaluating patients post-EZD.