CLINICAL AND PARACLINICAL CORRELATIONS AND TREATMENT OF THE PATIENTS WITH ZENKER’S DIVERTICULUM

Diana Ciuc; Rodica Bîrlă; C. Marica; S. Constantinoiu

doi:10.33695/jss.v5i2.156

Diana Ciuc CFR 2 Clinic Hospital Bucharest, ENT Department
Rodica Bîrlă “Carol Davila” University of Medicine and Pharmacy Bucharest
C. Marica “Carol Davila” University of Medicine and Pharmacy Bucharest; The Center of Excellence in Oesophageal Surgery “Sfanta Maria” Clinical Hospital
S. Constantinoiu “Carol Davila” University of Medicine and Pharmacy Bucharest; The Center of Excellence in Oesophageal Surgery “Sfanta Maria” Clinical Hospital

DOI: https://doi.org/10.33695/jss.v5i2.156

Keywords: Zenker's diverticulum, dysphagia, diverticulectomy, cricopharyngeal myotomy

Abstract

Zenker’s diverticulum is a rare disease, clinically manifested by dysphagia, particularly at the aged patients, with multiple comorbidities. The aim of this study is to correlate the age of the patients with their gender, number of symptoms upon hospitalization, period of hospitalization, post-interventional symptomatology (remaining dysphagia, degree of dysphagia, sialorrhea), dimension of the diverticulum, dimensional classification of the diverticulum, presence of diverticulitis, type of intervention, myotomy, resection of the diverticulum, re-intervention, intra-procedural complications, post-procedural complications, comorbidities, and to correlate the dimensions of the diverticula with the degrees of dysphagia at the patients with Zenker’s diverticulum. We have included in the study 36 patients with cervicomediastinal Zenker’s diverticula treated in the period 2010/ 2017 in two academic clinics: 7 patients with classic surgical method, at the Clinic of General and Oesophageal Surgery – Clinical Hospital “Sfanta Maria” of Bucharest, and 29 patients with endoscopic procedure, at the Department of Diagnostic and Interventional Digestive Endoscopy within the Regional Institute of Hepatology and Gastroenterology “Prof Dr Octavian Fodor” of Cluj-Napoca. The age of the patients was between 42 and 84 years old, and 15 patients were in their 70s. Comparing the patients aged below 70s (N=21) to the lot of patients aged above 70s (N=15), there is no statistically significant difference as regards gender, symptomatology, degree of dysphagia, dimension or degree of the diverticulum, presence of diverticulitis, type of intervention, period of hospitalization, presence of complications or necessity of re-intervention.

In the study lot, 55.6% of the patients had 2^nd degree dysphagia. The ENT-related symptomatology was present at 10 patients out of the 36 who were in the study and consisted in dysphonia, cough, odynophagia, and was associated with oesophageal manifestations at 70% of the patients. Most of the patients had 1^st and 2^nd degree diverticula, only 4 patients had 3^rd degree diverticula. Comparing the dimensions of the diverticula, expressed in centimetres, with the degrees of dysphagia, upon the patients’ coming to the hospital, no statistical significance can be seen. The patients over 70 years old do not present more advanced stages of the disease, they do not need different treatment and they have no different prognostic as compared to the patients below 70. The patients without dysphagia had 1^st and 2^nd degree diverticula. Though not significant statistically, all the patients with 3^rd degree diverticula had dysphagia.