ATH-05 Can protocolised measurements with barium radiology predict severity and treatment outcomes in zenker’s diverticulum?

Introduction Barium swallow is an established investigation for Zenker’s diverticulum (ZD), yet, no agreed measurement protocol exists for the evaluation of ZD on Barium radiology. We developed a standardised protocol to measure ZD dimensions on Barium radiology, and aimed to correlate ZD dimensions with symptoms, procedural difficulty and treatment outcomes. Methods This prospective single-centre study included patients with symptomatic ZD undergoing flexible endoscopic septal division (FESD) as day case procedures between 2014–2018. Patients underwent Barium swallow imaging; ZD dimensions (figure 1) were measured and agreed by two expert radiologists using a predefined protocol. Symptom severity pre- and post-FESD was recorded using the Dysphagia, Regurgitation, Complications (DRC) scale.1 Procedural difficulty was rated on a three-point scale: easy, moderate, difficult. The primary outcome was therapeutic success, defined as remission following single episode FESD with a DRC score of 1 or less art 6 months of follow-up. ZD dimensions were subjected to Mann-Whitney tests and logistic regression analyses. Results In total, 68 patients (mean age 74.2, SD 11.8) underwent barium radiology. Male gender comprised 60.9% of the cohort and was associated with larger pouch height (P=0.008), width (P=0.004) and depth (P=0.045). A positive correlation was identified between baseline DRC score and pouch depth (rho 0.319, P=0.012), particularly the symptom of regurgitation (P=0.009). No significant associations were found between ZD dimensions and procedural difficulty. Overall, each patient underwent an average of 1.4 FESD procedures. The outcome of therapeutic success at 6-months was achieved in 69% and was associated with shorter pouch height (median 14.5 mm vs. 19 mm, P=0.030) and pouch width (median 20 mm vs. 28 mm, P=0.046), with smaller cricopharyngeal length tending towards significance (median 20.8 mm vs. 26.3 mm, P=0.051). On multivariable analysis using a forward stepwise approach, pouch height was the sole dimension affecting the study outcome, with each additional mm in pouch height associated with a decrement in the probability of therapeutic success (OR 0.946, 95% CI: 0.897–0.997, P=0.031).Abstract ATH-05 Figure 1 Conclusions ZD dimensions may be feasibly evaluated using Barium radiology. Specific parameters, especially those relating to the pouch, appear to correlate with baseline severity and post-FESD patient outcomes. These results may inform the planning of FESD in day case patients with ZD. Reference Battaglia G, Dig Endosc 2015. PMID: 25975384.