Functional and manofluorographic outcomes after transoral endoscopic pharyngoesophageal diverticulostomy.
OBJECTIVE
To investigate functional and manofluorographic findings of patients with pharyngoesophageal diverticulum before and after transoral endoscopic pharyngoesophageal diverticulostomy (TEPD) and to comment on outcomes relative to predictors of successful treatment and pathogenesis of pharyngoesophageal diverticulum.


METHODS
Retrospective medical record review.


METHODS
Academic center.


METHODS
Thirty patients underwent TEPD between July 1, 1997, and June 30, 2007, and met the study inclusion criteria. According to the depth of their pharyngoesophageal diverticulum, patients were categorized as having small (<20 mm) or large (>or=20 mm) diverticula.


METHODS
Manofluorography before and 6 months after TEPD.


METHODS
Functional and manofluorographic findings before and 6 months after surgery.


RESULTS
Functional Outcome Swallowing Scale stage was significantly decreased in patients after surgery. Videofluoroscopy demonstrated normal swallowing coordination and a significant decrease in pouch depth after surgery (from 29.62 to 4.78 mm). Manometry confirmed normal swallowing coordination and showed significant mean postoperative pressure reductions in the following: cricopharyngeal (CP) resting pressure (from 16.23 to 9.26 mm Hg), CP midbolus pressure (from 32.86 to 19.26 mm Hg), intrabolus pressure gradient across the CP region (from 22.48 to 10.16 mm Hg), and CP peak clearing pressure (from 41.98 to 26.99 mm Hg). The mean preoperative intrabolus pressure gradient across the CP region and the mean postoperative CP nadir were significantly greater in patients having large diverticula.


CONCLUSIONS
Statistically significant decreases in functional and objective measures occurred after TEPD. High CP midbolus pressure and high intrabolus pressure gradient across the CP region are reliable objective indicators of patients who might benefit from TEPD and are appropriate variables for follow-up after surgery. There was no manofluorographic evidence of abnormal swallowing coordination in this small series. Our study supports the hypothesis that anatomical hypopharyngeal wall weakness has a major role in the pathogenesis of pharyngoesophageal diverticulum.
Ozgursoy
Ozan B
OB
Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Florida, Jacksonville, FL 32224, USA. OzanOzgursoy@yahoo.com
Salassa
John R
JR
D000368:Aged; D000704:Analysis of Variance; D003679:Deglutition / Q000502:physiology; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011859:Radiography; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome; D016672:Zenker Diverticulum / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*