Cricopharyngeus Muscle Dysfunction and Hypopharyngeal Diverticula (e.g., Zenker): A Multicenter Study

Abstract

Objective To describe demographics and imaging and compare findings and symptoms at presentation in a large cohort of persons with cricopharyngeus muscle dysfunction (CPMD) with and without hypopharyngeal diverticula. Methodology Prospective, multicenter cohort study of all individuals enrolled in the Prospective OUtcomes of Cricopharyngeal Hypertonicity (POUCH) Collaborative. Patient survey, comorbidities, radiography, laryngoscopy findings, and patient‐reported outcome measures (e.g., Eating Assessment Tool [EAT‐10]) data were abstracted from a REDCap database and summarized using means, medians, percentages, and frequencies. Diagnostic categories were compared using analysis of variance. Results A total of 250 persons were included. The mean age (standard deviation [SD]) of the cohort was 69.0 (11.2). Forty‐two percent identified as female. Zenker diverticula (ZD) was diagnosed in 85.2%, 9.2% with CPMD without diverticula, 4.4% with a Killian Jamieson diverticula (KJD), and 1.2% traction‐type diverticula. There were no differences between diagnostic categories in regard to age, gender, and duration of symptoms (p = 0.25, 0.19, 0.45). The mean (SD) EAT‐10 score for each group was 17.1 (10.1) for ZD, 20.2 (9.3) for CPMD, and 10.3 (9.4) for KJD. Patients with isolated CPMD had significantly greater EAT‐10 scores compared to the other diagnostic groups (p = 0.03). Conclusion ZD is the most common, followed by CPMD without diverticula, KJD, and traction‐type. Patients with isolated obstructing CPMD may be more symptomatic than persons with ZD or KJD. Level of Evidence 4 Laryngoscope, 133:1349–1355, 2023

Postoperative Care of Zenker Diverticula: Contemporary Perspective from the Prospective OUtcomes Cricopharyngeaus Hypertonicity (POUCH) Collaborative

“…Surgical intervention is not without risk and should be evaluated in the context of the patients' age, symptoms, and overall health via shared decision‐making 13,15,16 . In a previous work of the POUCH Collaborative, open approaches were associated with greater improvement in dysphagia scores than endoscopic approaches based on patient reported outcome measures; however, open approaches were also associated with a higher complication rate 11 . The latter was corroborated in the current study.…”

“…Postoperative esophagography was obtained in 61 patient of 278 known data points (22.3%) at a median (IQR) 2.5 1,11 days (Table I). Thirty (49.2%) were in the 23‐h observation group, 7 (11.5%) in the 48‐h and 24 (39.3%) were >48‐h inpatient group.…”

“…ZD is a surgical disease impacting a not insignificant proportion of the population 12–14 . Both open and endoscopic approaches are reliable and effective treatment modalities based on patient reported outcomes 9,11 . Surgical intervention is not without risk and should be evaluated in the context of the patients' age, symptoms, and overall health via shared decision‐making 13,15,16 .…”

“…IRB approval was individually obtained by each of 11 institutions enrolled in the POUCH Collaborative. This is a prospectively collected, longitudinal REDCap database for patients with CPMD with or without diverticula and with and without surgery, previously described by Howell et al 10 Patients with an intraoperative diagnosis of ZD (of any size) between August 1, 2017 and February 1, 2023 were included. Demographics were extracted directly from the database.…”

“…Demographics were extracted directly from the database. Surgical approaches were categorized as: (1) endoscopic procedure, defined as a purely trans‐oral approach without an external incision versus (2) open procedure, defined as any approach to the diverticulum using an external cervical incision 11 . Endoscopic techniques included in our data were laser, stapler ligasure, botox injection, and balloon dilation.…”