Skip to main content

Advertisement

SpringerLink
Log in

Endoscopic stapling of Zenker’s diverticulum: establishing national baselines for auditing clinical outcomes in the United Kingdom

  • Review Article
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Endoscopic stapling of Zenker’s diverticulum (ZD) is now established practice in the UK and is routinely performed by the vast majority of otolaryngologists. Both The National Confidential Enquiry into Peri-Operative Deaths and the National Institute for Health and Clinical Excellence recommended that the procedure be undertaken at specialist centres and that each department should audit their respective outcomes. Despite the abundance of review articles, it remains unclear what variables a meaningful audit is required to collate and what gold standards every department in the UK undertaking surgery for ZD should aspire to achieve. The objective was to review the outcomes of endoscopic stapling of Zenker’s diverticulum at this institution. In addition, a review of other UK departments was undertaken to formulate minimum clinical standards and recommendations of best practice. Review of patient case notes and a structured search of PubMed were used as materials. Fifteen retrospective case series were identified from the literature search which fulfilled the inclusion criteria. Fifty-one patients were identified from the present audit. When these were added to the review, a total of 585 patients were available for meta-analysis. 540 (92.3%) were successfully stapled. Forty-five (7.7%) procedures were abandoned intra-operatively. The most common reason was difficulty assessing the small pouch. The majority of patients (92%) had resumed oral intake by the second post-operative day. Most patients (87%) were discharged by the second post-operative day. Outcomes were good with over 90% reporting resolved or significantly improved symptoms. Minor complications included dental trauma, transient hoarseness and sore throat causing delayed resumption of oral intake. The overall perforation rate was 4.8%. One death was reported. In conclusion endoscopic stapling of pharyngeal pouch is a safe procedure that is associated with good outcomes and low complication rates. No death has been reported since 2000 in the UK. The data presented in this review represent current clinical standards reported over the past 15 years by UK departments and serve as a useful benchmark for any future audits undertaken. Level of evidence 3A.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Newbegin CJ (1996) Endoscopic stapling diverticulotomy of pharyngeal pouch. Ann R Coll Surg Engl 78:400–401

    PubMed  CAS  Google Scholar 

  2. Siddiq MA, Sood S (2004) Current management in pharyngeal pouch surgery by UK otorhinolaryngologists. Ann R Coll Surg Engl 86:247–252

    Article  PubMed  CAS  Google Scholar 

  3. Pharyngeal pouch surgery. The Report of the National Confidential Enquiry into Perioperative Deaths 1996/19977. http://www.ncepod.org.uk/1996_7.htm. Accessed 6 August, 2011

  4. IPG22 Interventional procedure overview of endoscopic stapling of pharyngeal pouch. http://www.nice.org.uk/Guidance/IPG22, Accessed 6 August, 2011

  5. Koay CB, Bates GJ (1996) Endoscopic stapling diverticulotomy for pharyngeal pouch. Clin Otolaryngol Allied Sci. 21:371–376

    Article  PubMed  CAS  Google Scholar 

  6. Baldwin DL, Toma AG (1998) Endoscopic stapled diverticulotomy: a real advance in the treatment of hypopharyngeal diverticulum. Clin Otolaryngol Allied Sci 23:244–247

    Article  PubMed  CAS  Google Scholar 

  7. van Eeden S, Lloyd RV, Tranter RM (1999) Comparison of the endoscopic stapling technique with more established procedures for pharyngeal pouches: results and patient satisfaction survey. J Laryngol Otol 113:237–240

    PubMed  Google Scholar 

  8. Sood S, Newbegin CJ (2000) Endoscopic stapling of pharyngeal pouches in patients from the Yorkshire region. J Laryngol Otol 114:853–857

    Article  PubMed  CAS  Google Scholar 

  9. Jaramillo MJ, McLay KA, McAteer D (2001) Long-term clinico-radiological assessment of endoscopic stapling of pharyngeal pouch: a series of cases. J Laryngol Otol 115:462–466

    PubMed  CAS  Google Scholar 

  10. Counter PR, Hilton ML, Baldwin DL (2002) Long-term follow-up of endoscopic stapled diverticulotomy. Ann R Coll Surg Engl 84:89–92

    PubMed  CAS  Google Scholar 

  11. Mirza S, Dutt SN, Minhas SS, Irving RM (2002) A retrospective review of pharyngeal pouch surgery in 56 patients. Ann R Coll Surg Engl 84:247–251

    Article  PubMed  CAS  Google Scholar 

  12. Raut VV, Primrose WJ (2002) Long-term results of endoscopic stapling diverticulotomy for pharyngeal pouches. Otolaryngol Head Neck Surg 127:225–229

    Article  PubMed  Google Scholar 

  13. Weller MD, Porter MJ, Rowlands J (2004) An audit of pharyngeal pouch surgery using endoscopic stapling: the patient’s viewpoint. Eur Arch Otorhinolaryngol 261:331–333

    Article  PubMed  CAS  Google Scholar 

  14. Casso C, Lalam M, Ghosh S, Timms M (2006) Endoscopic stapling diverticulotomy: an audit of difficulties, outcome, and patient satisfaction. Otolaryngol Head Neck Surg 134:288–293

    Article  PubMed  Google Scholar 

  15. Tsikoudas A, Eason D, Kara N, Brunton JN, Mountain RE (2006) Correlation of radiologic findings and clinical outcome in pharyngeal pouch stapling. Ann Otol Rhinol Laryngol 115:721–726

    PubMed  Google Scholar 

  16. Paleri V, Najim O, Meikle D, Wilson JA (2007) Microlaryngoscopic repair of iatrogenic pharyngeal pouch perforations: treatment of choice? Head Neck 29:189–192

    Article  PubMed  Google Scholar 

  17. Lieder A, Nasseri F, Sharma A, Jani P (2008) Safety and efficacy of endoscopic pharyngeal pouch stapling in a large UK study. Clin Otolaryngol 33:127–130

    Article  PubMed  CAS  Google Scholar 

  18. Harris RP, Weller MD, Porter MJ (2010) A follow up audit of pharyngeal pouch surgery using endoscopic stapling. Eur Arch Otorhinolaryngol 267:939–943

    Article  PubMed  Google Scholar 

  19. Yeo JC, Mackenzie K (2010) Pharyngeal pouch surgery in north Glasgow: NICE (National Institute for Health and Clinical Excellence) practice or not? J Laryngol Otol 124:533–537

    Article  PubMed  CAS  Google Scholar 

  20. Kubba H, Hussain SS (1998) Stapler failure in pharyngeal diverticulectomy: a suggested modification in surgical technique. J R Coll Surg Edinb 43:31–32

    PubMed  CAS  Google Scholar 

  21. Hilton M, Brightwell AP (2000) Oesophageal perforation during stapling of a pharyngeal pouch: adverse clinical incident report. J Laryngol Otol 114:549–550

    Article  PubMed  CAS  Google Scholar 

  22. Arunachalam PS, Cameron DS (2001) Persistent foreign body sensation and pharyngeal pain due to retention of staples: an interesting sequelae of endoscopic stapling procedure. J Laryngol Otol 115:425–427

    Article  PubMed  CAS  Google Scholar 

  23. Nix PA (2001) Delayed oesophageal perforation following endoscopic stapling of a pharyngeal pouch. J Laryngol Otol 115:668

    PubMed  CAS  Google Scholar 

  24. Porter MJ, Kim D (2010) Endoscopic pharyngeal pouch surgery as a day case. Clin Otolaryngol 35:162–163

    Article  PubMed  CAS  Google Scholar 

  25. Jennings SJ, Wild DC, Beasley N, Sharp JF (2006) How we do it: improving the success of endoscopic pharyngeal pouch stapling. Clin Otolaryngol 31:550–552

    Article  PubMed  CAS  Google Scholar 

  26. Chang CY, Payyapilli RJ, Scher RL (2003) Endoscopic staple diverticulostomy for Zenker’s diverticulum: review of literature and experience in 159 consecutive cases. Laryngoscope 113:957–965

    Article  PubMed  Google Scholar 

  27. Mirza S, Dutt SN, Irving RM (2003) Iatrogenic perforation in endoscopic stapling diverticulotomy for pharyngeal pouches. J Laryngol Otol 117:93–98

    Article  PubMed  CAS  Google Scholar 

  28. Sen P, Bhattacharyya AK (2004) Endoscopic stapling of pharyngeal pouch. J Laryngol Otol 118:601–606

    Article  PubMed  CAS  Google Scholar 

  29. van Overbeek JJ (2003) Pathogenesis and methods of treatment of Zenker’s diverticulum. Ann Otol Rhinol Laryngol 112:583–593

    PubMed  Google Scholar 

  30. Bradley PJ, Kochaar A, Quraishi MS (1999) Pharyngeal pouch carcinoma: real or imaginary risks? Ann Otol Rhinol Laryngol 108:1027–1032

    PubMed  CAS  Google Scholar 

  31. Veenker E, Cohen JI (2003) Current trends in management of Zenker diverticulum. Curr Opin Otolaryngol Head Neck Surg 11:160–165

    Article  PubMed  Google Scholar 

  32. Spinelli P, Ballardini G (2003) Botulinum toxin type A (Dysport) for the treatment of Zenker’s diverticulum. Surg Endosc 17:660

    PubMed  CAS  Google Scholar 

  33. Katsinelos P, Chatzimavroudis G, Zavos C, Pilpilidis I, Paroutoglou G, Kountouras J (2009) Long-term botulinum toxin treatment for dysphagia due to large epiphrenic diverticulum in elderly patients: a report of two cases. Dysphagia 24:109–113

    Article  PubMed  Google Scholar 

  34. Hilton M, Brightwell AP (2000) Oesophageal perforation during stapling of a pharyngeal pouch: adverse clinical incident report. J Laryngol Otol 114:549–550

    Article  PubMed  CAS  Google Scholar 

  35. Bloom JD, Bleier BS, Mirza N, Chalian AA, Thaler ER (2010) Factors predicting endoscopic exposure of Zenker’s diverticulum. Ann Otol Rhinol Laryngol 119:736–741

    PubMed  Google Scholar 

  36. Visosky AM, Parke RB, Donovan DT (2008) Endoscopic management of Zenker’s diverticulum: factors predictive of success or failure. Ann Otol Rhinol Laryngol 117:531–537

    PubMed  Google Scholar 

  37. Allen J, White CJ, Leonard R, Belafsky PC (2010) Effect of cricopharyngeus muscle surgery on the pharynx. Laryngoscope 120:1498–1503

    Article  PubMed  Google Scholar 

  38. Gross ND, Cohen JI, Andersen PE (2004) Outpatient endoscopic Zenker diverticulotomy. Laryngoscope 114:208–211

    Article  PubMed  Google Scholar 

  39. Belafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J, Leonard RJ (2008) Validity and reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol 117:919–924

    PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, Royal Liverpool University Hospital, Link 3Z (ENT), Prescot Street, Liverpool, L7 8XP, UK

    Samuel C. Leong, Mark D. Wilkie & Christopher J. Webb

Authors
  1. Samuel C. Leong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark D. Wilkie
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christopher J. Webb
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Samuel C. Leong.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Leong, S.C., Wilkie, M.D. & Webb, C.J. Endoscopic stapling of Zenker’s diverticulum: establishing national baselines for auditing clinical outcomes in the United Kingdom. Eur Arch Otorhinolaryngol 269, 1877–1884 (2012). https://doi.org/10.1007/s00405-012-1945-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-012-1945-3

Keywords

Search

Navigation