Zenker Diverticulum: Does Size Correlate with Preoperative Symptoms?

Abstract

Introduction Zenker diverticulum (ZD) usually affects adults after the 7th decade of life. Treatment for ZD is indicated for all symptomatic patients, but some patients prefer to defer surgical treatment until symptoms get worse and decrease their quality of life. Objective To evaluate the association of the preoperative symptoms in ZD patients with the size of the ZD. Methods A retrospective study design. Electronic medical records were used to identify patients diagnosed with ZD and treated over 11 years. Data collection included the chief complaints and symptoms, medical history, and findings on radiologic swallow evaluations of the patients. The diverticulum size was stratified into 3 groups: small (< 1 cm), moderate (1–3 cm), and large (> 3 cm). Results A total of 165 patients were enrolled and stratified by diverticulum size (48 small, 67 medium, and 50 large). Dysphagia, cough, and regurgitation were the most prevalent symptoms. Dysphonia was more frequent among patients with a small pouch. Logistic regression analysis showed that dysphagia and choking were associated with large and medium diverticulum size (p < 0.05). Additionally, dysphonia was significantly associated with the presence of a small-sized ZD (p < 0.04). Conclusion Upper gastrointestinal symptoms such as dysphagia and choking may be associated with a ZD > 1 cm and should always be evaluated. Additionally, the presence of dysphonia was found to be correlated with a ZD < 1 cm, suggesting that a prompt and appropriate fluoroscopic evaluation must be considered in those patients in whom no other clear cause of dysphonia is evident.

Pharyngoesophageal diverticulum mimicking thyroid nodules: Some interesting ultrasonographic signs

“…Killian–Jamieson diverticulum is an uncommon condition, resulting from herniation of the Laimer membrane leading to a defect of the esophagus in the gullet ( 8 ). Common clinical presentations include dysphagia, regurgitation, choking, chronic cough, aspiration pneumonitis, globus, weight loss and, less commonly, dysphonia ( 10 ). For decades, the mainstay of treatment for ZD was an open surgical approach through a neck incision with performance of myotomy of the UES and removal or suspen-alternative and often preferable incisionless transoral approaches have been developed ( 11 ).…”

Postoperative Complications and Reoperative Surgery in the Treatment of Patients With Zenker Diverticulum

“…Some studies have recommended that the size of the diverticulum be considered when choosing a surgical approach . Diverticulum size may also be associated with symptom profile or severity, which may be associated with a patient’s choice to undergo surgical treatment …”

“…25,31,[49][50][51] Diverticulum size may also be associated with symptom profile or severity, which may be associated with a patient's choice to undergo surgical treatment. 14,52 Surprisingly, very few PIC claims were found, suggesting that injury claims are rarely filed by patients with ZD. Only claims filed by patients who received surgery by otolaryngology and thoracic surgery specialists were represented, and no claims were filed by patients who underwent operations performed by specialists of general surgery, gastrointestinal surgery, or gastroenterology.…”