Zenker's Diverticulum: Can Protocolised Measurements with Barium SWALLOW Predict Severity and Treatment Outcomes? The "Zen-Rad" Study.
Sauid Ishaq, Keith Siau, Minhong Lee and 8 others
PMID 32562140WHAT IT FOUND
In 67 patients with Zenker's diverticulum treated by endoscopic division, durable remission after one procedure occurred in 64.2%.
Some barium measurements were associated with success only before adjusting for age, sex and prior surgery.
Key findings
01Durable remission after a single flexible endoscopic septal division occurred in 64.2% of patients. Shorter cricopharyngeus length, pouch height and pouch width were associated with success, but not after accounting for age, previous surgery or gender.
02Two radiologists independently measured the first 10 cases. Agreement was excellent for pouch width and pouch depth, but oesophageal depth was unreliable and removed from later analyses.
03Measured pouch dimensions did not correlate with dysphagia or complication scores. Pouch depth and pouch neck correlated with regurgitation, and pouch depth correlated with the composite Dysphagia, Regurgitation, Complications score.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study included 67 patients from one tertiary centre, so the correlations and success rate may be imprecise and may not apply to other settings. Only the first 10 cases were measured independently by two radiologists, so the reliability estimates are limited. Some barium studies were performed externally with variable equipment and acquisition parameters, which may affect measurement consistency. Follow-up barium swallow was not routinely performed after treatment, so residual pouch size and recurrence were not directly assessed. Therapeutic success required durable remission at 6 months after a single procedure, which is stricter than definitions used in some other work. The cohort was older, had comorbidity, and included 30 patients with previous surgical stapling, so results may not generalise to other patient populations. No significant associations with therapeutic success remained after accounting for age, previous surgery or gender, so the measurements are not shown to predict success independently.
The easy way to misread this
Do not conclude that barium measurements independently predict who will have durable remission after endoscopic division. Shorter cricopharyngeus length, pouch height and pouch width were associated with success, but not after accounting for age, previous surgery or gender, and the study was observational in 67 patients.