The Laryngoscope Lippincott Williams & Wilkins, Inc. © 2007 The American Laryngological, Rhinological and Otological Society, Inc. Dysphagia After Endoscopic Repair of Zenker’s Diverticulum Andrew D. Palmer, MS; Heather C. Herrington, MD; Ionel C. Rad, MD; James I. Cohen, MD, PhD, FACS Objectives/Hypothesis: To determine whether pa- tient outcomes after endoscopic staple-assisted di- verticulectomy (ESD) were correlated with demo- graphic or disease-specific patient characteristics. Study Design: Retrospective chart review with follow- up. Methods: A survey was sent to all eligible subjects who had undergone ESD from February 1995 to June 2004 to gather information about their postoperative weight, diet, dysphagia symptoms, distress, and over- all satisfaction. Results: Thirty-five individuals re- sponded (49% response rate) at a mean of 29 (range, 3– 83) months postoperative. There was a significant reduction in the following symptoms: food avoidance, regurgitation, dysphagia for pills, choking, coughing, difficulty finishing a meal, heartburn/reflux, and ha- litosis. There was no significant difference for dys- phonia. Swallow-related distress had decreased from a preoperative level of 7.86 to 2.23 at follow-up (P < .001). Overall satisfaction with the surgery was high. There were no significant differences in outcome by any demographic characteristic, duration of preoper- ative symptoms, presence of gastroesophageal reflux disease, Zenker’s diverticulum size, time since sur- gery, or number of surgeries. Ninety-one percent of subjects reported improvement in their swallowing after surgery, but 22% reported some decline since that time. Symptomatic subjects reported signifi- cantly higher swallow-related distress and lower sat- isfaction (P < .01). Preoperative variables were not correlated with a return of symptoms. Individuals who underwent multiple procedures had similar lev- els of benefit and satisfaction as those who under- went a single ESD procedure. Conclusion: ESD results in high levels of patient satisfaction, significant re- duction in postoperative symptoms, low levels of com- plications, and the opportunity to safely and success- fully repeat the procedure if necessary. Key Words: Zenker’s diverticulum, endoscopic diverticulostomy, cricopharyngeal myotomy, dysphagia. Laryngoscope, 117:617– 622, 2007 INTRODUCTION Occurring in an area of natural weakness between the fibers of the inferior pharyngeal constrictor and the cricopharyngeus muscle known as Killian’s dehiscence, a Zenker’s diverticulum (ZD) is a well-known clinical entity. Numerous methods of managing the diverticular sac have been tried over the course of the 20th century with varying levels of success. 1 Recently, endoscopic staple-assisted di- verticulectomy (ESD) has gained popularity as a treat- ment method because of the relatively high success levels and low complication rates. 2 Nonetheless, there is general agreement that ESD is not the intervention of choice for all patients: exclusionary criteria have included reduced jaw-opening and limited neck extension because of diffi- culties with exposure 3 and diverticula that are either very small 4,5 or very large. 6,7 To date, there have been numer- ous studies that have compared outcomes and patient satisfaction across different procedures, but there is little information regarding whether preoperative patient char- acteristics are predictive of differences in outcomes. MATERIALS AND METHODS Patient Population A retrospective chart review of all patients with a ZD who had been scheduled for ESD at Oregon Health and Science Uni- versity (OHSU) between February 1995 and June 2004 was per- formed with the approval of the institutional review board at OHSU. The names of 105 individuals were obtained by this means. Of these, a total of 33 were excluded from further analysis because the endoscopic approach had been aborted (n = 9), the patient had undergone an open ZD at a later date (n = 6), the patient had a medical comorbidity associated with dysphagia (n = 5), or the patient was deceased (n = 13). Thus, a total of 72 patients were eligible for inclusion in the follow-up study. Procedure All patients included in the study underwent ESD, as has been previously described. 3 After the administration of general anesthesia, the bivalved diverticuloscope is introduced transor- ally, and the ZD is exposed. Ideally, the anterior blade of the diverticuloscope is introduced into the introitus of the esophagus, and with opening of the distal portion of the scope, the posterior From the Department of Otolaryngology–Head and Neck Surgery (A.D.P., J.I.C.), Oregon Health and Science University, Portland, Oregon; Oregon Health and Science University (H.C.H.), Portland, Oregon; and the Department of Surgery (I.C.R.), University of Southern California, Los Angeles, California. Editor’s Note: This Manuscript was accepted for publication Novem- ber 29, 2006. Send correspondence to Dr. James I. Cohen, Department of Otolar- yngology–Head and Neck Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, PV-01, Portland, OR 97239-3098. E-mail: cohenj@ohsu.edu DOI: 10.1097/MLG.0b013e3180305061 Laryngoscope 117: April 2007 Palmer et al.: Dysphagia After Diverticulectomy 617