Fiberoptic endoscopic evaluation of swallowing findings in individuals with Zenker’s diverticulum and cricopharyngeal bar

Purpose To assess fiberoptic endoscopic evaluation of swallowing (FEES) findings in individuals with cricopharyngeal bar (CPB) and Zenker’s diverticulum (ZD). Methods In this retrospective chart review spanning from 2010–2018, individuals diagnosed with CPB or ZD and undergoing FEES were identified. Patient demographics, radiographic studies, and treatments were recorded, and findings were compared between CPB, ZD of < 3 cm, and ZD ≥ 3 cm. Results Sixty-one individuals consisting of 48 patients with ZD and 13 patients with CPB met inclusion criteria. Post-swallow hypopharyngeal reflux (PSHR) of undigested food bolus, present with or without Valsalva maneuver, was noted in 23%, 84%, and 75% of patients with CPB, ZD < 3 cm, and ZD ≥ 3 cm, respectively. The sensitivity and specificity of the finding for those with ZD were 81% and 83%, respectively. Of patients with ZD, reflux resolved in all but six individuals after surgery. Four of these patients underwent revision surgery with the reflux subsequently resolving, and two patients with persistent reflux were asymptomatic and did not desire further treatment. Conclusions PSHR is a good tool to identify the presence of a ZD and is less helpful to identify a CPB. Elimination of PSHR is a good tool to determine treatment success in patients with ZD and CPB. Level of evidence IV.