Differentiating Persistent and Recurrent Dysphagia in Zenker Diverticulum: A POuCH Study

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OBJECTIVES: To define persistent and recurrent dysphagia after surgery for CPMD with and without diverticula. METHODS: Patients with CPMD with and without diverticula enrolled in the Prospective Outcomes of Cricopharyngeus Hypertonicity (POuCH) multicenter study who underwent surgery from November 2014 to August 2024 with at least 12 months of follow up were included. Surgical outcomes were evaluated using a validated patient reported dysphagia marker, Eating Assessment Tool 10 (EAT10), where normal is characterized as < 3. Persistent dysphagia is defined as patients with < 50% improvement in EAT-10 or EAT-10 score ≥ 3 at first follow up. Recurrent dysphagia is an initial surgical responder with a delayed worsening in EAT-10 scores during follow-up. RESULTS: A total of 160 patients were included. Six patients (3.7%) had recurrent dysphagia, with 5 undergoing re-operation. A total of 23 patients (14.3%) had persistent dysphagia immediately post-operatively; one underwent re-operation. Preoperative EAT-10 scores were higher in the persistent group (median 23.5, interquartile interval (IQR) 12.0-28.5) compared to responders (14.0, 8-24) (p = 0.05). Median first post-operative EAT-10 in the persistent dysphagia group was 14 (IQR 8-21) compared to 0 in the responders (0-2; p < 0.0001). There was no difference in esophageal pathology. There was no difference in rates of response to endoscopic versus open surgery. CONCLUSION: Patients with recurrent dysphagia are less common than persistent dysphagia, and there are no clear markers to predict surgical responders from persistent dysphagia (e.g., non-responders), however all non-responders occurred in the first 12 months after surgery.

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