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C-reactive protein as an early marker of postoperative leakage in patients after endoscopic laser assisted Zenker’s diverticulotomy

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Abstract

Background and aim

Minimally invasive endoscopic techniques are the treatment of choice for Zenker’s diverticulum (ZD). Our objective was to evaluate the results and efficacy of endoscopic and open approaches, to determine whether postoperative C-reactive protein (CRP) serum levels can be used as a marker to exclude the presence of esophageal leakage, and to identify risk factors for development of postoperative leakage and complications.

Materials and methods

Patients who underwent transcervical myotomy and diverticulotomy (TMD) or endoscopic cricopharyngeal myotomy (ECM) with CO2 laser for ZD in years 2008–2021 at our department were included in this retrospective study.

Results

Of the 101 patients enrolled, 83 patients underwent ECM and 18 TMD. The procedure time of the endoscopic technique was significantly shorter compared to that of transcervical method (p < 0.001). The median time to oral intake was 6 days for ECM and 10.5 days in the TMD group (p < 0.001). There was a 13% (n = 11) and 16.7% (n = 3) symptomatic recurrence rate and 3.6% (n = 3) and 16.7% (n = 3) major complications rate for ECM and TMD groups, respectively. The incidence of contrast leak (CL) evaluated by postoperative swallow study was 8.9% (9 from 83 patients in the ECM group only). In patients with CL, a significant increase in CRP levels on postoperative day (POD) 2 and 3 was detected when compared to patients without CL.

Conclusions

Endoscopic diverticulotomy with CO2 laser represents a safe and efficient treatment of ZD. Elevation of postoperative CRP serum levels over 123.8 mg/L on POD2 and 98.8 mg/L on POD3 may indicate presence of an esophageal leakage.

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Availability of data and materials

The data that support the findings of this study are not openly available due to reasons of sensitivity personal data and are available in electronic version (Excel document) from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Motol, First Faculty of Medicine, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic

    Martin Kana, David Kalfert, Petr Lukes, Michal Zabrodsky & Jan Plzak

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  1. Martin Kana
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Correspondence to David Kalfert.

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This article does not contain any animal studies conducted by the authors. The study was conducted in accordance with the guidelines of the Helsinki Declaration and its subsequent amendments. Retrospective study does not require approval by an ethical committee in our country.

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Informed consent was not needed; it is a retrospective study.

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Kana, M., Kalfert, D., Lukes, P. et al. C-reactive protein as an early marker of postoperative leakage in patients after endoscopic laser assisted Zenker’s diverticulotomy. Eur Arch Otorhinolaryngol 280, 2007–2016 (2023). https://doi.org/10.1007/s00405-022-07764-2

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