Abstract
The aim of this study was to evaluate the clinical relevance and prognostic value of preoperative and postoperative oesophagography in patients with Zenker’s diverticulum. The medical records of 155 patients who underwent surgical treatment (with an endoscopic or transcervical approach) for Zenker’s diverticulum between 1992 and 2010 in a tertiary referral centre were retrospectively evaluated. The size of the diverticula on oesophagography, recognizable muscular septum, and protection of the diverticulum were assessed relative to the surgical procedures performed. The incidence of diverticular remnants on postoperative oesophagography was also assessed relative to the surgical procedure. It was investigated whether the detection of a residual pharyngeal pouch and filling of it with contrast medium were related to the patients’ immediate postoperative symptoms and the development of symptomatic recurrence. Larger diverticula (Brombart III–IV) were manageable significantly more often with endoscopic procedures (P = 0.007). Residual diverticulum and filling with contrast medium were strongly associated with prolonged dysphagia immediately postoperatively (P = 0.005 and P = 0.009, respectively). However, these parameters failed to correlate significantly with a symptomatic recurrence. Preoperative oesophagography proved to be extremely important for surgical planning, with the surgeon’s personal preference seeming to be the driving indicator in many cases. Postoperative oesophagography is only useful for excluding postoperative complications in the immediate postoperative phase and did not have a prognostic value as to a recurrence of the disease.
Similar content being viewed by others
References
Allen BC, Baker ME, Falk GW (2009) Role of barium esophagography in evaluating dysphagia. Cleve Clin J Med 76:105–111
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
Sydow BD, Levine MS, Rubesin SE, Laufer I (2001) Radiographic findings and complications after surgical or endoscopic repair of Zenker’s diverticulum in 16 patients. AJR Am J Roentgenol 177(5):1067–1071
Brombart M (1953) Zenker’s pharyngo-esophageal diverticulum; pathogenic considerations on radiological studies on 26 cases (23 cases in initial stage). J Belge Radiol 36:166–197
Zbären PSP, Tschopp L, Becker M, Häusler M (1999) Surgical treatment of Zenker’s diverticulum: transcutaneous diverticulectomy versus microendoscopic myotomy of the cricopharyngeal muscle with CO2 laser. Otolaryngol Head Neck Surg 121:482–487
Koch M, Mantsopoulos K, Velegrakis S, Iro H, Zenk J (2011) Endoscopic laser-assisted diverticulotomy versus open surgical approach in the treatment of Zenker’s diverticulum. Laryngoscope 121:2090–2094
Keck TRA, Grün PM (2010) Surgical treatment of hypopharyngeal diverticulum (Zenker’s diverticulum). Eur Arch Otorhinolaryngol 267:587–592
Visosky AMPR, Donovan DT (2008) Endoscopic management of Zenker’s diverticulum: factors predictive of success or failure. Ann Otol Rhinol Laryngol 117:531–537
Mantsopoulos K, Psychogios G, Künzel J, Zenk J, Iro H, Koch M (2012) Evaluation of the different transcervical approaches for Zenker diverticulum. Otolaryngol Head Neck Surg 146:725–729
Chang CWBB, Netterville JL, Courey MS, Garrett CG, Bayles SW (2004) Carbon dioxide laser endoscopic diverticulotomy versus open diverticulectomy for Zenker’s diverticulum. Laryngoscope 114:519–527
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
Ekberg O, Besjakov J, Lindgren S (1987) Radiographic findings after cricopharyngeal myotomy. Acta Radiol 28:555–558
Witterick IJ, Gullane PJ, Yeung E (1995) Outcome analysis of Zenker’s diverticulectomy and cricopharyngeal myotomy. Head Neck 17:382–388
Hadley JM, Ridley N, Djazaeri B, Glover G (1997) The radiological appearances after the endoscopic crico-pharyngeal myotomy: Dohlman’s procedure. Clin Radiol 52:613–615
Ong CC, Elton PG, Mitchell D (1999) Pharyngeal pouch endoscopic stapling—are post-operative barium swallow radiographs of any value? J Laryngol Otol 113:233–236
Van Overbeek JJ (1994) Meditation on the pathogenesis of hypopharyngeal (Zenker’s) diverticulum and a report of endoscopic treatment in 545 patients. Ann Otol Rhinol Laryngol 103:178–185
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mantsopoulos, K., Psychogios, G., Karatzanis, A. et al. Clinical relevance and prognostic value of radiographic findings in Zenker’s diverticulum. Eur Arch Otorhinolaryngol 271, 583–588 (2014). https://doi.org/10.1007/s00405-013-2562-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-013-2562-5