Prevalence of Coexisting Esophageal Findings in Patients With Zenker’s Diverticulum

Introduction: Persistent dysphagia after repair of Zenker’s diverticulum (ZD) is well-described but its causes are not completely understood. This study examines the prevalence of co-existing esophageal findings in patients with ZD and assesses differences in postoperative swallowing outcomes compared to patients without esophageal abnormalities (ZD-only).

Methods: A retrospective review of patients undergoing endoscopic repair of ZD at a tertiary medical center between 2014 and 2021 was performed. Esophageal findings were collected from preoperative videofluoroscopic swallow studies, esophagrams, and esophagoscopy procedures. Patient-reported swallowing outcomes were measured using Eating Assessment Tool (EAT-10) scores.

Results: Of 55 patients (23 women, mean age 73.25 years) undergoing endoscopic repair of ZD, 43 had co-existing esophageal findings (78.18%). Hernias were most frequently reported (n=31, 56.36%), followed by dysmotility (n=26, 47.27%), esophageal ring or web (n=16, 29.09%), gastroesophageal reflux (n=13, 23.63%), strictures (n=6, 10.91%), and esophagitis (n=5, 9.09%). Postoperative EAT-10 scores were significantly improved for the entire cohort (P < .05). Patients with co-existing esophageal findings had a trend toward higher postoperative EAT-10 scores (5.5 vs. 2.5, P=.21).

Conclusions: The prevalence of concurrent esophageal findings in patients presenting with ZD is markedly high, underscoring the importance of performing comprehensive swallowing evaluations in such patients. Additional investigations are needed to assess the impact of co-existing esophageal findings on persistent postoperative dysphagia in ZD patients. Regardless of esophageal findings, addressing ZD improves patient’s postoperative symptoms and appropriate ZD surgery should be pursued for thoughtfully selected patients.