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Dysphagia Characteristics in Zenker’s Diverticulum

Objective: To evaluate the presenting signs and symptoms of dysphagia in patients with Zenker’s diverticulum (ZD). Method: All patients surgically treated for ZD over a 6-year period were identified. Charts were reviewed for dysphagia history and findings on fiberoptic endoscopic evaluation of swallowing (FEES). Dysphagia symptoms and swallowing abnormalities were compared across groups based upon diverticulum size (small <1 cm, medium 1-3 cm, and large >3 cm). Results: Forty-one patients were identified. ZD size was available in 39 cases (6 small, 18 medium, 15 large). Regurgitation symptoms were less frequent in patients with small (17%) compared to medium (70%) or large diverticula (73%) (P < .01). Similarly, esophagopharyngeal reflux (EPR) on FEES was less frequent in patients with small (17%) compared to medium (88%) and large diverticula (92%) (P < .01). EPR was present in all patients presenting for revision surgery (N = 9). In all cases, EPR resolved after successful treatment. Eighteen percent of all patients had evidence of pharyngeal weakness on FEES which did not change significantly on initial postoperative exam. Conclusion: Dysphagia with EPR is predictive of a ZD larger than 1 cm, and may be useful in preoperative planning. EPR is also helpful in identifying patients with recurrent or residual symptomatic ZD following surgical treatment. Pharyngeal weakness is present in a subset of ZD patients.