Long-term experience with endoscopic staple-assisted esophagodiverticulostomy for Zenkers diverticulum.
Scher RL. Richtsmeier WJ.
Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
The authors have previously described the endoscopic staple-assisted esophagodiverticulostomy (ESED) technique for treatment of Zenker's diverticulum. In the initial series of six patients, ESED was shown to be safe and effective in the short term, with a significant reduction in hospital stay and convalescence as compared with other surgical techniques. This report documents the authors' long-term experience with ESED (average follow-up, 9.3 months; range, 1.5 to 25 months) and discusses the long-term results of this therapy, technical issues, and variations they have utilized, as well as the advantages and limitations of this approach. Thirty-six patients with Zenker's diverticula have been treated from March 1995 to March 1997. In 34 of the patients, ESED was accomplished, resulting in successful resolution of preoperative symptoms in 32 (94%). Two patients had persistent dysphagia after initial ESED; a revision ESED was successfully performed without complication in both. Two patients were unable to be treated with ESED because of inability to expose the diverticulum with the Weerda laryngoscope. Oral liquid diet has been resumed, on average, 0.8 days after surgery (range, 0 to 4 days), with solid diet resumed by day 5 (range, 1 to 14 days). The average hospital stay has been 1.3 days (range, 1 to 4 days). There have been no postoperative deaths, infections, or airway difficulties. Perioperative morbidity to date has included one case of iatrogenic pharyngeal perforation, one postoperative fever, one transient true vocal fold paralysis, and two dental injuries, with no long-term sequelae. The results support the use of ESED as the initial treatment of choice for patients with Zenker's diverticula.
Videoendoscopic swallowing study for diagnosis of Zenkers diverticuli.
Richardson BE. Bastian RW.
Loyola Voice and Swallowing Institute, Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois 60153, USA.
The videoendoscopic swallowing study (VESS) provides an efficient, cost-effective method for swallowing evaluation in the clinic. Previously thought to be of little value for disorders of the proximal esophagus, this retrospective study (n = 33) demonstrates a high level of sensitivity (85%) and specificity (86%) of VESS for detecting Zenker's diverticuli in patients with symptoms of swallowing dysfunction. Furthermore, the key finding of postswallow reflux into the hypopharynx reliably distinguishes cricopharyngeus dysfunction from diverticuli in this population. This study shows that VESS can provide useful information about the proximal esophagus.
New laryngeal muscle weakness in post-polio syndrome.
Robinson LR. Hillel AD. Waugh PF.
Department of Rehabilitation Medicine, University of Washington, Seattle, USA.
The authors describe the clinical presentations of post-polio laryngeal muscle weakness in three patients with prior polio infection who presented with new complaints including slowly progressive dyspnea, dysphagia, and/or hoarseness. Evaluations by laryngeal videostroboscopy and electromyography revealed vocal cord abductor and/or adductor weakness, recurrent posterior glottic web in one case, and, in the two patients who agreed to electromyography, evidence of prior denervation and reinnervation in laryngeal muscles. Treatment was directed at attempting to maintain an airway and optimize vocal quality. One patient benefitted from tracheostomy, one benefitted from vocal cord medialization, and one benefitted from resection of interarytenoid scarring. The authors conclude that diagnosis of laryngeal post-polio syndrome is facilitated by laryngeal electromyography. Interventions directed at maintaining an appropriate airway and optimizing vocal quality may be helpful.