Characterizing a CT esophagram protocol after flexible endoscopic diverticulotomy for Zenker’s diverticulum: a retrospective series

BackgroundFlexible endoscopic cricopharyngeal myotomy and septotomy offer a minimally invasive transluminal option for the treatment of symptomatic Zenker's diverticulum (ZD). There is currently no consensus regarding postoperative follow-up imaging. We suggest a standardized computed tomograph...

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Bibliographic Details
Published in:	Translational gastroenterology and hepatology Vol. 7; p. 34
Main Authors:	Banerjee, Debdeep, Magnelli, Laura L., Oliva, Mailin, Malik, Neha, Ginsburg, Brittney M., Grajo, Joseph R., Brar, Tony S., Westerveld, Donevan R., Yang, Dennis, Draganov, Peter V.
Format:	Journal Article
Language:	English
Published:	AME Publishing Company 01-10-2022
Subjects:	Original
Online Access:	Get full text
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Summary:	BackgroundFlexible endoscopic cricopharyngeal myotomy and septotomy offer a minimally invasive transluminal option for the treatment of symptomatic Zenker's diverticulum (ZD). There is currently no consensus regarding postoperative follow-up imaging. We suggest a standardized computed tomography (CT) esophagram protocol for radiographic evaluation of postoperative findings. MethodsSingle center retrospective analysis of patients with symptomatic ZD who underwent flexible endoscopic diverticulotomy and postoperative imaging with CT esophagram from January 2015 to March 2020. An experienced radiologist blinded to the initial imaging reports prospectively interpreted all CT esophagram findings, in order to minimize bias. ResultsTwenty-one patients underwent CT esophagram following flexible endoscopic diverticulotomy for ZD. Diverticulotomy was technically successful in all patients. Most common findings on imaging included: atelectasis (13/21; 62%), persistent esophageal diverticulum (7/21; 33%), pneumomediastinum (3/21; 14%), aspiration (2/21; 10%), and extraluminal air and contrast extravasation consistent with focal esophageal perforation (1/21; 5%). ConclusionsWe describe a standardized, simple, and accessible CT esophagram protocol for postoperative imaging of patients with post-flexible endoscopic cricopharyngeal myotomy and septotomy for ZD. CT esophagram facilitates a definitive exclusion of focal esophageal perforation as a postoperative complication of flexible endoscopic diverticulotomy by ruling out extraluminal air and contrast extravasation.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ORCID: 0000-0002-5154-1822. Contributions: (I) Conception and design: D Banerjee, JR Grajo, D Yang, PV Draganov; (II) Administrative support: D Banerjee, TS Brar, DR Westerveld, PV Draganov; (III) Provision of study materials or patients: LL Magnelli, TS Brar, JR Grajo, D Yang, PV Draganov; (IV) Collection and assembly of data: D Banerjee, LL Magnelli, M Oliva, N Malik, BM Ginsburg; (V) Data analysis and interpretation: D Banerjee, LL Magnelli, JR Grajo, D Yang, PV Draganov; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.
ISSN:	2415-1289 2415-1289
DOI:	10.21037/tgh-20-269