Short-term Quality-of-Life Outcomes following Transoral Diverticulotomy for Zenker’s Diverticulum: A Prospective Single-Group Study

• Published in: Otolaryngology-head and neck surgery 2016-02, Vol.154 (2), p.322-327
• Main Authors: Van Abel, Kathryn M., Tombers, Nicole M., Krein, Kari A., Moore, Eric J., Price, Daniel L., Kasperbauer, Jan L., Hinni, Michael L., Lott, David G., Ekbom, Dale C.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Deglutition - physiology; Female; Follow-Up Studies; Humans; Male; Middle Aged; Mouth; Natural Orifice Endoscopic Surgery - methods; Prospective Studies; Quality of Life; Retrospective Studies; Surveys and Questionnaires; Treatment Outcome; Zenker Diverticulum - physiopathology; Zenker Diverticulum - psychology; Zenker Diverticulum - surgery
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1177/0194599815616078

Objective To prospectively analyze quality-of-life outcomes following transoral diverticulotomy with cricopharyngeal myotomy (DCPM) for Zenker’s diverticulum (ZD). Study Design Prospective single-group study. Settings Tertiary academic institution. Subjects and Methods A prospective multicenter study performed from January 1, 2012, to July 1, 2014, included 18 patients presenting with ZD undergoing DCPM. Standardized questionnaires—including the 10-item Eating Assessment Tool (EAT-10), Functional Outcome of Swallowing Scale (FOSS), and the Reflux Symptom Index (RSI)—were completed preoperatively and at 3 and 6 months postoperatively. Videofluoroscopic studies were obtained and analyzed by our senior speech-language pathologist, who was blinded to the clinical outcomes. Results Eighteen patients were included (11 women; mean age, 72.6 years; range, 53-86 years). All patients had ZD on preoperative videofluoroscopic swallowing studies. The most common comorbidities included hypertension (10 of 18, 55.6%), dyslipidemia (8 of 18, 44.4%), hiatal hernia (6 of 18, 33.3%), and gastroesophageal reflux disease (5 of 18, 27.8%). Median preoperative RSI was 27 (interquartile range [IQR], 22.5-31.5); FOSS, 2 (IQR, 2-3); and EAT-10, 21.5 (IQR, 13.5-27.5). The 3-month questionnaire (88.9% completion) demonstrated an improved median RSI of 5 (IQR, 1-7.5; P < .001), FOSS of 0 (IQR, 0; P < .001), and EAT-10 of 0 (IQR, 0-3; P < .001). Fourteen patients (77.8%) completed the 6-month questionnaire, demonstrating a median RSI of 4 (IQR, 0-8), FOSS of 0 (IQR, 0-0.5), and EAT-10 of 1 (IQR, 0-3). While regurgitation decreased following surgery (P = .007), nighttime cough did not (P = .25). Conclusion This study supports an improvement in functional outcome and quality of life in patients with ZD undergoing DCPM.