Dysphagia Outcomes in Zenker Diverticulum: A Longitudinal POuCH Study

Objective: Patients with cricopharyngeus muscle dysfunction (CPMD) with and without diverticula (e.g., Zenker Diverticulum) often struggle with dysphagia for years prior to diagnosis or intervention. Surgical treatment is successful; yet, there is limited long-term data on dysphagia outcomes after surgery. Methods: Individuals prospectively enrolled in the Prospective Outcomes of Cricopharyngeal Hypertonicity (POuCH) collaborative with and without diverticula who underwent surgery from November 2014 to August 2024 and had at least 12 months of follow-up were included. Eating Assessment Tool 10 (EAT10) was used to characterize patient-reported outcomes. Descriptive statistics were performed using means, frequencies, and spaghetti plots. Results: Of 164 patients initially identified, 2 withdrew and 2 were excluded for incomplete data; 160 were included. 31% were women, with a mean (SD) age of 70.1 (11.5). Endoscopic surgery (113, 71%) was more common than open technique (47, 29%). 19.4% of patients had undergone previous surgery. Postoperatively, patients were found to have improved EAT-10 scores, with smaller changes recorded after 36 months. Median change in EAT-10 compared to preoperative score was −12 points [IQR: −18, −5] at 12 months. 39 (24%) patients were followed for > 24 months (median change −11 [IQR: −14, −7]); 26 (16%) > 36 months (−9.5 [−17, −5]), and 12 (7.5%) > 48 months (−4 [IQR: −18, 4]). Six patients died during the study period. Conclusion: Improved dysphagia after surgery appears stable with minimal change over time. Most patients (96.3%) survive at least 1 year. Surgical intervention for patients with CPMD with or without diverticula is an effective and reliable treatment option. Level of Evidence: 4.