Unintentional Weight Loss Does Not Predict Poor Outcomes in Zenker Diverticulum

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OBJECTIVE: Weight loss is frequently considered a cardinal presenting symptom for patients with Zenker diverticulum (ZD). We hypothesized that weight loss in patients with cricopharyngeal muscle dysfunction (CPMD), with or without diverticula, was associated with the length of symptoms and size of diverticulum. METHODS: Prospective, multicenter observational study of CPMD patients with and without diverticula reporting unintentional weight loss (+WL) or no weight loss (-WL) prior to enrollment in the Prospective Outcomes of Cricopharyngeal Hypertonicity (POuCH) database. Complications and symptom response using a patient reported outcome measure, the Eating Assessment Tool (EAT-10), were compared. RESULTS: Of 427 patients, 101 (23.6%) were +WL. Median weight loss was 14 pounds (interquartile range [IQR] 10-25). +WL cohort had a mean age of 71.5 (standard deviation [SD] 11.5) vs. 67.9 in -WL (SD 11.6, p = 0.007). Mean preoperative EAT-10 score was 24.7 in +WL (SD 9.7) and 14.8 in -WL (SD 8.8, p < 0.0001). Higher preoperative weight loss was associated with higher preoperative EAT-10 (p < 0.0001, Spearman's ρ = 0.43). Size of diverticulum was associated with WL (p = 0.003), but weight loss was highest in both large diverticula and CP bars. Duration of symptoms was not associated with weight loss (p = 0.30). Postoperative complications in +WL and -WL patients were similar (p = 0.78). CONCLUSION: Unintentional weight loss is common with ZD. Patients with worse dysphagia are more likely to have more weight loss. Weight loss does not increase with the size of the diverticulum or length of symptoms. Surgery has a similar safety profile with greater improvement in dysphagia in patients reporting weight loss.

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