Hostname: page-component-848d4c4894-8kt4b Total loading time: 0 Render date: 2024-06-20T07:09:38.386Z Has data issue: false hasContentIssue false
  • English
  • Français

A multi-centre analysis of a decade of endoscopic pharyngeal pouch surgery in Cheshire and Merseyside

Published online by Cambridge University Press:  03 November 2020

T Hampton ,
J Allan ,
D Pearson ,
H Emerson ,
G H Jones ,
M Junaid ,
T Kanzara ,
A S Lau ,
R Siau  and
S P Williams
...Show all authors
T Hampton*
Affiliation:
Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK Department of ENT Surgery, Liverpool University Hospitals NHS Foundation Trust, UK
J Allan
Affiliation:
Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK Department of ENT Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
D Pearson
Affiliation:
Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK Department of ENT Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
H Emerson
Affiliation:
Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK Department of ENT Surgery, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, UK
G H Jones
Affiliation:
Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK Department of ENT Surgery, Liverpool University Hospitals NHS Foundation Trust, UK
M Junaid
Affiliation:
Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK Department of ENT Surgery, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, UK
T Kanzara
Affiliation:
Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK Department of ENT Surgery, Mid Cheshire Hospitals NHS Trust, Crewe, UK
A S Lau
Affiliation:
Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK Department of ENT Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
R Siau
Affiliation:
Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK Department of ENT Surgery, Liverpool University Hospitals NHS Foundation Trust, UK
S P Williams
Affiliation:
Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK Department of ENT Surgery, Countess of Chester Hospital NHS Foundation Trust, Chester, UK
M D Wilkie
Affiliation:
Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, UK Department of ENT Surgery, Liverpool University Hospitals NHS Foundation Trust, UK
*
Author for correspondence: Mr T Hampton, Mersey ENT Trainee Research Collaborative, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK E-mail: Thomas.hampton@nhs.net
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

There are sparse data on the outcomes of endoscopic stapling of pharyngeal pouches. The Mersey ENT Trainee Collaborative compared regional practice against published benchmarks.

Methods

A 10-year retrospective analysis of endoscopic pharyngeal pouch surgery was conducted and practice was assessed against eight standards. Comparisons were made between results from the tertiary centre and other sites.

Results

A total of 225 procedures were performed (range of 1.2–9.2 cases per centre per year). All centres achieved 90 per cent resumption of oral intake within 2 days. All centres achieved less than 2-day hospital stays. Primary success (84 per cent (i.e. abandonment of endoscopic stapling in 16 per cent)), symptom resolution (83 per cent) and recurrence rates (13 per cent) failed to meet the standard across the non-tertiary centres.

Conclusion

Endoscopic pharyngeal pouch stapling is a procedure with a low mortality and brief in-patient stay. There was significant variance in outcomes across the region. This raises the question of whether this service should become centralised and the preserve of either tertiary centres or sub-specialist practitioners.

Keywords

PharynxZenker DiverticulumEndoscopyBenchmarkingRetrospective Studies
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 134 , Issue 10 , October 2020 , pp. 925 - 930
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Mr T Hampton takes responsibility for the integrity of the content of the paper

References

Patel, N, Singh, T. Cricopharyngeal dysphagia. In: Watkinson, JC, Clarke, RW, eds. Scott-Brown's Otorhinolaryngology Head and Neck Surgery, 8th edn, Volume 3. Boca Raton, FL: CRC Press, 2019;811–27Google Scholar
Martino, R, McCulloch, T. Therapeutic intervention in oropharyngeal dysphagia. Nat Rev Gastroenterol Hepatol 2016;13:665–79CrossRefGoogle ScholarPubMed
Siddiq, MA, Sood, S, Strachan, D. Pharyngeal pouch (Zenker's diverticulum). Postgrad Med J 2001;77:506–11CrossRefGoogle Scholar
Beard, K, Swanström, LL. Zenker's diverticulum: flexible versus rigid repair. J Thorac Dis 2017;9:S154–62CrossRefGoogle ScholarPubMed
Leong, 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;269:1877–84CrossRefGoogle ScholarPubMed
Hondo, FY, Maluf-Filho, F, Giordano-Nappi, JH, Neves, CZ, Cecconello, I, Sakai, P. Endoscopic treatment of Zenker's diverticulum by harmonic scalpel. Gastrointest Endosc 2011;74:666–71CrossRefGoogle ScholarPubMed
Martin-Hirsch, DP, Newbegin, CJR. Autosuture GIA gun: a new application in the treatment of hypopharyngeal diverticula. J Laryngol Otol 1993;107:723–5CrossRefGoogle ScholarPubMed
Collard, JM, Otte, JB, Kestens, PJ. Endoscopic stapling technique of esophagodiverticulostomy for Zenker's diverticulum. Ann Thorac Surg 1993;56:573–6CrossRefGoogle ScholarPubMed
NICE interventional procedures guidance [IPG22]. Endoscopic stapling of pharyngeal pouch, 2003. In: https://www.nice.org.uk/guidance/ipg22 [21 April 2020]Google Scholar
Siddiq, A, Sood, S. Current management in pharyngeal pouch surgery by UK otorhinolaryngologists. Ann R Coll Surg Engl 2004;86:247–52CrossRefGoogle ScholarPubMed
Resouly, A. Pharyngeal pouch surgery. In: Gray, AJG, Hoile, RW, Ingram, GS, Sherry, KM. The Report of the National Confidential Enquiry into Perioperative Deaths 1996/7. London: CEPOD, 1996;32Google Scholar
Van Eeden, S, Lloyd, RV, Tranter, RM. Comparison of the endoscopic stapling technique with more established procedures for pharyngeal pouches: results and patient satisfaction survey. J Laryngol Otol 1999;113:237–40CrossRefGoogle ScholarPubMed
Ear, Nose and Throat Surgery: GIRFT Programme National Specialty Report. In: https://gettingitrightfirsttime.co.uk/wp-content/uploads/2019/10/ENT-Report-Nov19-L-FINAL.pdf [21 April 2020]Google Scholar
Belafsky, PC, Mouadeb, DA, Rees, CJ, Pryor, JC, Postma, GN, Allen, J et al. Validity and reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol 2008;117:919–24CrossRefGoogle Scholar
Chen, AY, Frankowski, R, Bishop-Leone, J, Hebert, T, Leyk, S, Lewin, J et al. The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson Dysphagia Inventory. Arch Otolaryngol Head Neck Surg 2001;127:870–6Google Scholar
Robinson, K, Gatehouse, S, Browning, GG. Measuring patient benefit from otorhinolaryngological surgery and therapy. Ann Otol Rhinol Laryngol 1996;105:415–22CrossRefGoogle ScholarPubMed
Koay, CB, Sharp, HR, Bates, GJ. Current practice in pharyngeal pouch surgery in England and Wales. Ann R Coll Surg Engl 1997;79:190–4Google ScholarPubMed
Laing, MR, Murthy, P, Ah-See, KW, Cockburn, JS. Surgery for pharyngeal pouch: audit of management with short- and long-term follow-up. J R Coll Surg Edinb 1995;40:315–18Google ScholarPubMed
Ching, HH, Kahane, JB, Reeve, NH, Wang, RC. The plication technique to enhance the endoscopic approach to Zenker's diverticulum. Otolaryngol Head Neck Surg 2018;159:799–801CrossRefGoogle ScholarPubMed
Jones, D, Aloraini, A, Gowing, S, Cools-Lartigue, J, Leimanis, M, Tabah, R et al. Evolving management of Zenker's diverticulum in the endoscopic era: a North American experience. World J Surg 2016;40:1390–6CrossRefGoogle ScholarPubMed
Oestreicher-Kedem, Y, Wasserzug, O, Sagi, B, Carmel, NN, Zikk, D. Revision endoscopic stapler Zenker's diverticulotomy. Surg Endosc 2016;30:2022–5CrossRefGoogle ScholarPubMed
Veivers, D. Pharyngeal pouch: which technique? J Laryngol Otol 2015;129:S30–4CrossRefGoogle ScholarPubMed
Alwan, M, Phyland, D, Pudel, E, Booth, E, Vallance, N. Long term self-reported post-operative outcomes of endoscopic and open pharyngeal pouch repairs. Aust J Otolaryngol 2019;2:15CrossRefGoogle Scholar
Agalato, E, Jose, J, England, RJ. Is pharyngeal pouch stapling superior to open pharyngeal pouch repair? An analysis of a single institution's series. J Laryngol Otol 2016;130:873–7CrossRefGoogle ScholarPubMed
Bola, S, Ashman, A, Winter, S. Endoscopic pharyngeal pouch stapling: a retrospective study of 55 patients comparing intubation difficulty and body mass index as factors for success. Clin Otolaryngol 2020;45:135–8CrossRefGoogle Scholar
NHS Digital. Hospital Admitted Patient Care Activity. In: https://digital.nhs.uk/data-and-information/publications/statistical/hospital-admitted-patient-care-activity [21 April 2020]Google Scholar
BAETS. 2014 British Thyroid Association guidelines on the management of thyroid cancer. In: https://www.baets.org.uk/wp-content/uploads/2014-British-Thyroid-Association-guidelines-on-the-management-of-thyroid-cancer.pdf [21 April 2020]Google Scholar
Adam, MA, Thomas, S, Youngwirth, L, Hyslop, T, Reed, SD, Scheri, RP et al. Is there a minimum number of thyroidectomies a surgeon should perform to optimize patient outcomes? Ann Surg 2017;265:402–7CrossRefGoogle Scholar
Bauer, H, Honselmann, KC. Minimum volume standards in surgery – are we there yet? Visc Med 2017;33:106–16CrossRefGoogle Scholar
Markar, SR, Mackenzie, H, Lagergren, P, Hanna, GB, Lagergren, J. Surgical proficiency gain and survival after esophagectomy for cancer. J Clin Oncol 2016;34:1528–36CrossRefGoogle ScholarPubMed
Markar, SR, Mackenzie, H, Wiggins, T, Askari, A, Karthikesalingam, A, Faiz, O et al. Influence of national centralization of oesophagogastric cancer on management and clinical outcome from emergency upper gastrointestinal conditions. Br J Surg 2018;105:113–20CrossRefGoogle ScholarPubMed
Markar, SR, Mackenzie, H, Ni, M, Huddy, JR, Askari, A, Faiz, O et al. The influence of procedural volume and proficiency gain on mortality from upper GI endoscopic mucosal resection. Gut 2018;67:79–85CrossRefGoogle ScholarPubMed
NHS England. NHS Standard Contract for Cleft Lip and/or Palate Services Including Non-Cleft Velopharyngeal Dysfunction (VPD) (all ages). In: https://www.england.nhs.uk/wp-content/uploads/2013/06/d07-cleft-lip.pdf [21 April 2020]Google Scholar
Buchanan, MA, Riffat, F, Mahrous, AK, Fish, BM, Jani, P. Endoscopic or external approach revision surgery for pharyngeal pouch following primary endoscopic stapling: which is the favoured approach? Eur Arch Otorhinolaryngol 2013;270:1707–10CrossRefGoogle ScholarPubMed
Morton, RP, Bartley, JRF. Inversion of Zenker's diverticulum: the preferred option. Head Neck 1993;15:253–6CrossRefGoogle ScholarPubMed
van Overbeek, JJM, Groote, AD. Zenker's diverticulum. Curr Opin Otolaryngol Head Neck Surg 1994;2:55–8CrossRefGoogle Scholar