Comparison of preoperative and surgical measurements of Zenker’s diverticulum

• Published in: Surgical endoscopy Vol. 26; no. 7; pp. 2010 - 2015
• Main Authors: Pomerri, Fabio, Costantini, Mario, Dal Bosco, Chiara, Battaglia, Giorgio, Bottin, Raffaele, Zanatta, Lisa, Ancona, Ermanno, Muzzio, Pier Carlo
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01-07-2012; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Aged; Aged, 80 and over; Anesthesia; Barium; Barium Sulfate; Biological and medical sciences; Contrast Media; Deglutition Disorders - etiology; Deglutition Disorders - pathology; Deglutition Disorders - surgery; Endoscopy; Esophagoscopy; Esophagus; Female; Gastroenterology; General aspects; Gynecology; Hepatology; Humans; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Preoperative Care; Proctology; Radiography; Radiology; Surgery; Zenker Diverticulum - diagnostic imaging; Zenker Diverticulum - pathology; Zenker Diverticulum - surgery; Italy; Radiology; Endoscopy; Zenker’s diverticulum; Surgery; Hypopharynx; Medicine; Endoscopic surgery; Treatment; Diverticulum; Preoperative; Zenker's diverticulum; Comparative study
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-012-2146-2

Background
Zenker’s diverticulum (ZD) may be treated with a variety of endoscopic or open surgical techniques; the choice of treatment depends partly on the size of the diverticulum. The purpose of this study was to correlate ZD measurements obtained preoperatively and during surgery.
Methods
From March 2006 to November 2008, 20 consecutive patients (19 males; median age 64.5 (range 37–88) years) with dysphagia secondary to ZD were enrolled for this study. All patients had preoperative barium radiography of the pharynx and esophagus, and diagnostic endoscopy. Ten patients underwent transoral stapling diverticulostomy and ten had open surgery. The depth of the ZD was measured on radiographic views, at endoscopy and during surgery, focusing on the distance from the top of the septum to the bottom of the pouch. The ZD dimensions obtained radiologically and endoscopically were compared with those found during surgery. Correlations and agreements between measurements were assessed using Pearson’s correlation coefficients and method-comparison analysis, respectively.
Results
The median depth of the ZD was 2.9 cm (mean 2.95 ± 1.12 cm; range 1.5–6 cm), 3.0 cm (mean 3.24 ± 1.27 cm; range 1.7–6.8 cm), and 3.0 cm (mean 2.99 ± 1.01 cm; range 1.5–6 cm) when measured during surgery, radiology, and endoscopy, respectively. The correlation and agreement between the radiographic and surgical ZD measurements were good, whereas those between the endoscopic and surgical measurements were poor.
Conclusions
These findings confirm that preoperative barium radiography is mandatory in order to choose the most appropriate surgical treatment for ZD.