Zenker's Diverticulum: Can Protocolised Measurements with Barium SWALLOW Predict Severity and Treatment Outcomes? The "Zen-Rad" Study

Ishaq, Sauid and Siau, Keith and Lee, Minhong and Shalmani, Hamid M and Kuwai, Toshio and Priestnall, Lindsey and Muhammad, Humayun and Hall, Adrian and Mulder, Chris J and Neumann, Helmut and Aziz, Akhmid (2020) Zenker's Diverticulum: Can Protocolised Measurements with Barium SWALLOW Predict Severity and Treatment Outcomes? The "Zen-Rad" Study. Dysphagia. ISSN 1432-0460

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Abstract

Although barium swallow imaging is established in the investigation of Zenker's diverticulum (ZD), no agreed measurement protocol exists. We developed a protocol for measuring ZD dimensions and aimed to correlate measurements with symptoms and post-operative outcomes. This prospective study included patients with confirmed ZD who underwent flexible endoscopic septal division (FESD) between 2014 and 2018. ZD was confirmed on barium radiology with measurements reviewed by two consultant radiologists. Symptom severity pre- and post-FESD was measured using the Dysphagia, Regurgitation, Complications (DRC) scale. Regression analyses were conducted to identify dimensions associated with therapeutic success, defined as remission (DRC score ≤ 1) 6 months after index FESD. In total, 67 patients (mean age 74.3) were included. Interobserver reliability (intraclass correlation coefficients-ICCs) was greatest for pouch width (0.981) and pouch depth (0.934), but not oesophageal depth (0.018). Male gender (60.9%) was associated with larger pouch height (P = 0.008) and width (P = 0.004). A positive correlation was identified between baseline DRC score and pouch depth (ρ 0.326, P = 0.011), particularly the regurgitation subset score (ρ 0.330, P = 0.020). The index pouch depth was associated with FESD procedure time (rho 0.358, P = 0.041). Therapeutic success was achieved in 64.2% and was associated with shorter pouch height (median 14.5 mm vs. 19.0 mm, P = 0.030), pouch width (median 19.9 mm vs. 28.8 mm, P = 0.34) and cricopharyngeal length (median 20.2 mm vs. 26.3 mm, P = 0.036). ZD dimensions may be feasible and were evaluated using Barium radiology. Specific parameters appear to correlate with severity and post-FESD outcomes, which aid with pre-procedural planning.

Item Type:	Article
Additional Information:	** From PubMed via Jisc Publications Router ** History: received 10-02-2020; accepted 10-06-2020.
Identification Number:	10.1007/s00455-020-10148-5
Dates:	Date Event 10 June 2020 Accepted 19 June 2020 Published
Uncontrolled Keywords:	Deglutition, Deglutition disorder, Dysphagia, Myotomy, Zenker diverticulum
Subjects:	CAH01 - medicine and dentistry > CAH01-01 - medicine and dentistry > CAH01-01-01 - medical sciences (non-specific)
Divisions:	Faculty of Health, Education and Life Sciences > College of Health and Care Professions
SWORD Depositor:	JISC PubRouter
Depositing User:	JISC PubRouter
Date Deposited:	06 Jul 2020 13:27
Last Modified:	03 Mar 2022 15:37
URI:	https://www.open-access.bcu.ac.uk/id/eprint/9425

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