Abstract
Dysphagia affects the most cardinal of human functions: the ability to eat and drink. The aim of this prospective study was to evaluate swallowing dysfunction in patients diagnosed with Zenker’s diverticulum using the Swallowing Quality of Life (SWAL-QOL) questionnaire preoperatively. In addition, SWAL-QOL was used to assess changes in the outcome of swallowing function after endoscopic treatment of Zenker’s diverticulum compared to baseline. Pre- and postoperative SWAL-QOL data were analyzed in 25 patients who underwent endoscopic treatment of Zenker’s diverticulum between January 2011 and December 2013. Patients were treated by different endoscopic techniques, depending on the size of the diverticulum: CO2 laser technique or stapler technique, or the combination of both techniques used in larger diverticula. Their mean age was 69 years, and 28% of patients were female. The mean interval between endoscopic surgery and completion of the postoperative SWAL-QOL was 85 days. The median (min–max) preoperative total SWAL-QOL score was 621 (226–925) out of 1100, indicating the perception of oropharyngeal dysphagia and diminished quality of life. Following endoscopic treatment of Zenker’s diverticulum, significant improvement was demonstrated in the postoperative total SWAL-QOL score of 865 (406–1072) out of 1100 (p < 0.001). On the majority of subscales of SWAL-QOL there was significant improvement between pre- and postoperative scores. To the authors’ knowledge, this is the first report in the literature on the changes in pre- and postoperative SWAL-QOL scores for patients with Zenker’s diverticulum before and after treatment. The results of this study indicate that endoscopic treatment of Zenker’s diverticulum leads to significant symptom relief as documented by significant changes in the majority of the SWAL-QOL domains.
Similar content being viewed by others
References
van Overbeek JJ. Meditation on the pathogenesis of hypopharyngeal (Zenker’s) diverticulum and a report of endoscopic treatment in 545 patients. Ann Otol Rhinol Laryngol. 1994;103(3):178–85.
Ludlow A. A case of obstructed deglutition from a preternatural dilatation of and bag formed in the pharynx. Med Obs Inq. 1769;3:85–101.
Zenker FA, von Ziemssen H. Dilatations of the esophagus. Cycl Pract Med. 1878;3:46–8.
McHorney CA, Bricker DE, Kramer AE, Rosenbek JC, Robbins J, Chignell KA, Logemann JA, Clarke C. The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: I. Conceptual foundation and item development. Dysphagia. 2000;15(3):115–21. doi:10.1007/s004550010012.
McHorney CA, Bricker DE, Robbins J, Kramer AE, Rosenbek JC, Chignell KA. The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: II. Item reduction and preliminary scaling. Dysphagia. 2000;15(3):122–33. doi:10.1007/s004550010013.
McHorney CA, Robbins J, Lomax K, Rosenbek JC, Chignell K, Kramer AE, Bricker DE. The SWAL-QOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia in adults: III. Documentation of reliability and validity. Dysphagia. 2002;17(2):97–114. doi:10.1007/s00455-001-0109-1.
Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, Bouter LM, de Vet HC. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34–42. doi:10.1016/j.jclinepi.2006.03.012.
Vanderwegen J, Van Nuffelen G, De Bodt M. The validation and psychometric properties of the dutch version of the swallowing quality-of-life questionnaire (DSWAL-QOL). Dysphagia. 2012;. doi:10.1007/s00455-012-9408-y.
Bogaardt HC, Speyer R, Baijens LW, Fokkens WJ. Cross-cultural adaptation and validation of the Dutch version of SWAL-QoL. Dysphagia. 2009;24(1):66–70. doi:10.1007/s00455-008-9174-z.
Skaug HP, Geirdal AO, Brondbo K. Laser diverticulotomy for Zenker’s diverticulum–does it improve quality of life? Eur Arch Otorhinolaryngol. 2013;270(9):2485–90. doi:10.1007/s00405-013-2470-8.
Van Abel KM, Tombers NM, Krein KA, Moore EJ, Price DL, Kasperbauer JL, Hinni ML, Lott DG, Ekbom DC. Short-term quality-of-life outcomes following transoral diverticulotomy for Zenker’s diverticulum: a prospective single-group study. Otolaryngol–head neck surgery. 2016;154(2):322–7. doi:10.1177/0194599815616078.
Belafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J, Leonard RJ. Validity and reliability of the eating assessment tool (EAT-10). Ann Otol Rhinol Laryngol. 2008;117(12):919–24.
Szczesniak MM, Maclean J, Zhang T, Liu R, Cook IJ. The normative range for and age and gender effects on the sydney swallow questionnaire (SSQ). Dysphagia. 2014;29(5):535–8. doi:10.1007/s00455-014-9541-x.
Adam SI, Paskhover B, Sasaki CT. Laser versus stapler: outcomes in endoscopic repair of Zenker diverticulum. Laryngoscope. 2012;122(9):1961–6. doi:10.1002/lary.23398.
Verhaegen VJ, Feuth T, van den Hoogen FJ, Marres HA, Takes RP. Endoscopic carbon dioxide laser diverticulostomy versus endoscopic staple-assisted diverticulostomy to treat Zenker’s diverticulum. Head Neck. 2011;33(2):154–9. doi:10.1002/hed.21413.
Nielsen HU, Trolle W, Rubek N, Homoe P. New technique using LigaSure for endoscopic mucomyotomy of Zenker’s diverticulum: diverticulotomy made easier. The Laryngoscope. 2014;124(9):2039–42. doi:10.1002/lary.24558.
Aly A, Devitt PG, Watson DI, Jamieson GG, Bessell JR, Chew A, Krishnan S. Endoscopic stapling for pharyngeal pouch: does it make the cut? ANZ J Surg. 2004;74(3):116–21.
Miller FR, Bartley J, Otto RA. The endoscopic management of Zenker diverticulum: CO2 laser versus endoscopic stapling. Laryngoscope. 2006;116(9):1608–11. doi:10.1097/01.mlg.0000233508.06499.41.
Thaler ER, Weber RS, Goldberg AN, Weinstein GS. Feasibility and outcome of endoscopic staple-assisted esophagodiverticulostomy for Zenker’s diverticulum. Laryngoscope. 2001;111(9):1506–8. doi:10.1097/00005537-200109000-00002.
Sen P, Bhattacharyya AK. Endoscopic stapling of pharyngeal pouch. J laryngol otol. 2004;118(8):601–6. doi:10.1258/0022215041917817.
Chang CY, Payyapilli RJ, Scher RL. Endoscopic staple diverticulostomy for Zenker’s diverticulum: review of literature and experience in 159 consecutive cases. Laryngoscope. 2003;113(6):957–65. doi:10.1097/00005537-200306000-00009.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Colpaert, C., Vanderveken, O.M., Wouters, K. et al. Changes in Swallowing-related Quality of Life After Endoscopic Treatment For Zenker’s Diverticulum Using SWAL-QOL Questionnaire. Dysphagia 32, 339–344 (2017). https://doi.org/10.1007/s00455-017-9782-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00455-017-9782-6