Factors Predicting Endoscopic Exposure of Zenker's Diverticulum

Objectives: The objectives of this study were 1) to understand which anatomic variables are associated with failed endoscopic exposure of Zenker's diverticulum and 2) to enable preoperative selection of patients suitable for endoscopic repair of Zenker's diverticulum on the basis of anatomic variables. Methods: We performed a prospective, Institutional Review Board approved study of 30 patients undergoing attempted endoscopic repair of Zenker's diverticulum. Three categorical variables (sex, presence of maxillary dentition, and Mallampati score) and 6 continuous variables (age, neck circumference, hyomental distance, neck length, neck extension, and body mass index [BMI]) were collected before operation and then correlated to successful endoscopic exposure of the Zenker's pouch by use of a Fisher's exact test and Student's t-test, respectively. Results: Exposure was unsuccessful in 9 of 30 patients (30%). Factors that correlated significantly with exposure failure included a shorter neck length (7.2 +/- 1.2 cm; p = 0.047), a shorter hyomental distance (5.0 +/- 1.1 cm; p = 0.004), and a higher BMI (27.2 +/- 4.0 kg/m(2); p = 0.05). The presence of maxillary dentition did not reach significance in exposure failure, but did show a trend toward an association. Conclusions: Surgical exposure in endoscopic repair of Zenker's diverticulum tends to be significantly less successful in patients with short necks, decreased hyomental distance, and/or a high BMI. An open approach should be considered in this patient population.