Postoperative Fluoroscopic Appearance After Flexible Endoscopic Zenker's Diverticulotomy

Area of Science:

• Gastroenterology
• Otolaryngology
• Surgical Innovation

Background:

• Zenker's diverticulum (ZD) treatment is evolving towards flexible endoscopic approaches.
• Objective outcome measures for flexible Zenker's diverticulotomy are lacking.

Purpose of the Study:

• To quantitatively assess changes in videofluoroscopic swallowing studies (VFSS) after Zenker's per oral endoscopic myotomy (Z-POEM).
• To evaluate fluoroscopic and clinical outcomes of the Z-POEM technique for ZD.

Main Methods:

• Retrospective review of patients undergoing Z-POEM for ZD (July 2022 - December 2024).
• Primary outcomes: diverticulum size, pharyngoesophageal segment opening (PESo), pharyngeal constriction ratio (PCR), penetration aspiration scale (PAS).
• Secondary outcome: Eating Assessment Tool-10 (EAT-10) score.

Main Results:

• Significant reduction in diverticulum size (1.076 cm to 0.469 cm, p<0.001).
• Improved lateral PESo (0.392 cm to 0.709 cm, p<0.001) and decreased EAT-10 scores (16.59 to 6.35, p=0.001).
• Increased PCR (0.0746 to 0.0583, p=0.03) noted; no significant change in AP PESo or PAS.

Conclusions:

• Z-POEM is a fluoroscopically and clinically effective treatment for Zenker's diverticulum.
• The technique demonstrates significant improvement in swallowing dysfunction and patient-reported outcomes.