Abstract
Objective: Zenker's diverticulum (ZD) is usually associated with dysphagia and other symptoms due to the interrelated functions of several systems. Surgical management of ZD is effective for all sizes of diverticula, but not all patients decide to undergo surgery. The purpose of this study was to determine the relationship between clinical presentation and patients' decision to undergo surgical repair.Subjects and methods: This is a retrospective study including 165 patients with ZD treated over the last 11 years. Data collection includes patients' chief complaints and symptoms, medical history, findings on radiologic swallow evaluations, and patients' decision to undergo surgery. Pearson correlation and logistic regression analysis were performed.Results: Among our cohort, dysphagia was the most prevalent symptom (89.1%), followed by cough (65.5%) and regurgitation (58.8%). Dysphonia was prevalent among patients with a small-sized ZD. Our logistic regression model showed that patients' decision to undergo surgical repair could be predicted by diverticula size (β=1.10, p=0.002) and the presence of dysphagia (β=1.91, p=0.005), cough (β=1.01, p=0.042), and dysphonia (β=-1.37, p=0.024).Conclusion: Patients' decision to undergo surgery usually involves interrelated factors, including symptomatic burden, presence of comorbidities, and recommendation of the surgeon. This study has identified that diverticula size and the presence of dysphagia, cough, and dysphonia are significant factors influencing decision-making for surgical repair in patients with ZD.
Highlights
The functioning of the cricopharyngeus muscle, which is strategically placed between the pharynx and the esophagus, is vital for health
Our logistic regression model showed that patients' decision to undergo surgical repair could be predicted by diverticula size (β=1.10, p=0.002) and the presence of dysphagia (β=1.91, p=0.005), cough (β=1.01, p=0.042), and dysphonia (β=-1.37, p=0.024)
This study has identified that diverticula size and the presence of dysphagia, cough, and dysphonia are significant factors influencing decision-making for surgical repair in patients with Zenker's diverticulum (ZD)
Summary
The functioning of the cricopharyngeus muscle, which is strategically placed between the pharynx and the esophagus, is vital for health. Zenker's diverticulum (ZD) is an esophageal disorder believed to be caused by cricopharyngeal muscle dysfunction [1,2,3]. This pathology has a slight male predominance, and its peak incidence is between the seventh and ninth decades of life. Surgical management of ZD is recommended for symptomatic patients. These symptoms include regurgitation, choking, chronic cough, globus, weight loss, and, less commonly, dysphonia. Surgical treatment includes one of the following procedures: open transcervical diverticulectomy, endoscopic laser diverticulectomy, flexible endoscopic diverticulectomy, and endoscopic stapler-assisted diverticulectomy. A meta-analysis published in 2019 by Howell et al established no differences in outcomes between the different approaches and demonstrated that any surgical intervention yields a significant effect on postoperative symptom relief [7]
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