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Pharyngeal pouch: comparison of surgical treatment with botulinum toxin injection to the cricopharyngeus

  • K Lau (a1) and M G Watson (a1)
Abstract
Background

Pharyngeal pouch surgical treatments can be carried out via an endoscopic or open approach. Injection of botulinum toxin into the cricopharyngeus was first described as an alternative treatment to the more invasive surgical procedures performed for cricopharyngeal dysfunction. It has not been previously described as a treatment option for pharyngeal pouch.

Objectives

To compare operative time, average stay, complication rates and symptom control between endoscopic laser diverticulotomy, botulinum toxin injection and open procedures for pharyngeal pouch patients.

Methods

The medical records for 66 pharyngeal pouch procedures, carried out on 47 patients treated between 2011 and 2017, were identified and reviewed.

Results

The mean operative time was 21 minutes for botulinum toxin injection, 38 for endoscopic laser diverticulotomy and 104 for open surgery. The mean hospital stay was 0.6 days for botulinum toxin injection, 4.7 for endoscopic laser diverticulotomy and 4 for open surgery. The improvement in Reflux Symptom Index scores was statistically significant for both endoscopic laser diverticulotomy and botulinum toxin injection. Botulinum toxin injection had a 0 per cent complication rate.

Conclusion

Botulinum toxin injection is a safe and effective treatment for pharyngeal pouch.

Copyright
Corresponding author
Author for correspondence: Miss Kimberley Lau, ENT Department (c/o ENT secretaries), Doncaster Royal Infirmary, Thorne Road, Doncaster DN2 5LT, UK E-mail: kimberleylau@doctors.org.uk Fax: +(0)1302 647024
Footnotes
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Miss K Lau takes responsibility for the integrity of the content of the paper

Presented as a poster at the British Academic Conference in Otolaryngology, 4–6 July 2018, Manchester, UK.

Footnotes
References
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1National Institute for Health and Clinical Excellence. Endoscopic Stapling of Pharyngeal Pouch: Interventional Procedures Guidance. Manchester: NICE, 2003
2Albers, DV, Kondo, A, Bernardo, WM, Sakai, P, Moura, RN, Silva, GL et al. Endoscopic versus surgical approach in the treatment of Zenker's diverticulum: systematic review and meta-analysis. Endosc Int Open 2016;4:678–86
3Siddiq, M, Sood, S, Strachan, D. Pharyngeal pouch (Zenker's diverticulum). Postgrad Med J 2001;77:506–1110.1136/pmj.77.910.506
4Leong, SC, Wilkie, MD, Webb, CJ. Endoscopic stapling of Zenker's diverticulum: establishing national baselines for auditing clinical outcomes in the United Kingdom. Eur Arch Otorhinolaryngol 2012;269:1877–8410.1007/s00405-012-1945-3
5Schneider, I, Thumfart, WF, Pototschnig, C, Eckel, HE. Treatment of dysfunction of the cricopharyngeal muscle with botulinum A toxin: introduction of a new, noninvasive method. Ann Otol Rhinol Laryngol 1994;103:31–510.1177/000348949410300105
6Kelly, EA, Koszewski, IJ, Jaradeh, SS, Merati, AL, Blumin, JH, Bock, JM. Botulinum toxin injection for the treatment of upper esophageal sphincter dysfunction. Ann Otol Rhinol Laryngol 2013;122:100–810.1177/000348941312200205
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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
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