Postoperative Fluoroscopic Appearance After Flexible Endoscopic Zenker's Diverticulotomy

Flexible approach to treating Zenker's diverticulum (ZD) has gained traction in recent years. However, objective measures comparing pre- and post-surgical outcomes have not been reported. The purpose of this investigation is to describe the changes in quantitative measurements in videofluoroscopic swallowing studies (VFSS) after flexible Zenker's diverticulotomy using modern per oral endoscopic myotomy (Z-POEM) technique.

A retrospective review of all patients undergoing the Z-POEM technique for treatment of ZD was conducted from July 2022 to December 2024. The primary fluoroscopic outcome measures were the size of the diverticulum, pharyngoesophageal segment opening (PESo) in lateral and anterior-posterior (AP) views, pharyngeal constriction ratio (PCR), and penetration aspiration scale (PAS) score. The secondary outcome measure was the Eating Assessment Tool-10 (EAT-10) score.

Twenty-nine patients had pre- and post-surgical VFSS performed. The mean age was 74.1 years (±9.5) and 55% were male. The mean diverticulum size decreased from 1.076 cm (±0.702) to 0.469 cm (±0.573), p < 0.001. The mean PESo in lateral improved from 0.392 cm (±0.201) to 0.709 (±0.303), p < 0.001. The mean PCR increased from 0.0746 (±0.116) to 0.0583 (±0.102), p = 0.03. The mean EAT-10 score decreased from 16.59 (±8.7) to 6.35 (±7.03) (p = 0.001). There was no significant difference in postoperative PAS score or PESo in the AP view.

Our data indicate that flexible surgery for ZD using the Z-POEM technique is both fluoroscopically and clinically successful in improving swallowing dysfunction in patients suffering from Zenker's diverticulum.