Tu2004 Therapy of Zenker's Diverticulum With Flexible Endoscopy Versus a Rigid Endoscopic Approach: a Matched Cohort Study

Abstract

Introduction The effortful swallow (ES) is designed to increase tongue base to posterior wall contact in patients with reduced oropharyngeal pressure, hereby improving bolus clearance. However, the effect of bolus volume and consistency on swallowing during this maneuver is unclear. Hence, we aim to quantify the effect of ES on pressure flow metrics and its interaction with bolus volume and consistency in healthy subjects. Material and Methods 12 healthy controls (6M, 6F, mean age 32 years, 21-53 years) swallowed 3 bolus consistencies (liquid, semisolid, and solid) in 2 bolus volumes (small [5ml-2cm2] or large [10ml-4cm2]). All swallows were recorded with combined high resolution manometryimpedance (36P12Z catheter) and analyzed using AIMplot software, deriving swallowmetrics for the pharynx and upper esophageal sphincter (UES). Different mixed models were estimated with each AIM metric as dependent variable, and volume, consistency and head posture as within-subject independent variables. Pairwise differences were tested using posthoc t-tests corrected for multiple comparisons. Results No significant effect of ES on pharyngeal peak pressure was found (p=0.4) (Figure 1). ES significantly increased time from nadir impedance to pharyngeal peak pressure (p<0.0001) (Figure 2), indicating improved bolus propulsion compared to the head neutral position. Discussion This study shows that ES does not increase the strength of the pharyngeal contraction, but rather influences its timing with bolus flow. We believe this observation may be clinically relevant as ES is often the maneuver of choice in patients with pharyngeal hypocontractility. Our finding may contribute to the understanding of inconsistent treatment success while using this swallow maneuver.