Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA.
Department of Surgery, University of Auckland, Auckland, New Zealand.
Laryngoscope. 2023 Sep;133(9):2110-2115. doi: 10.1002/lary.30508. Epub 2022 Dec 1.
To assess barium esophagram (BAS) as a diagnostic marker for patients with Killian Jamieson diverticula (KJD).
Prospective, multicenter cohort study of individuals enrolled in the Prospective OUtcomes of Cricopharyngeus Hypertonicity (POUCH) Collaborative. Patient demographics, comorbidities, radiographic imaging reports, laryngoscopy findings, patient-reported outcome measures (PROM), and operative reporting were abstracted from a REDCap database and summarized using means, medians, percentages, frequencies. Paired t-tests and Wilcoxon Signed Rank test were used to test pre- to post-operative differences in RSI, EAT-10, and VHI-10 scores. Diagnostic test evaluation including sensitivity, specificity, positive, and negative predictive value with 95% confidence intervals were calculated comparing BAS findings to operative report.
A total of 287 persons were enrolled; 13 (4%) patients were identified with confirmed KJD on operative reports. 100% underwent open transcervical excision. BAS has a 46.2% (95% confidence interval [CI]: 23.2, 70.9) sensitivity and 97.8% (95% CI: 95.3, 99.0) specificity in detecting a KJD and 50% (95% CI: 25.4, 74.6) positive predictive value but 97.4% (95%CI: 94.8, 98.7) negative predictive value. Preoperatively, patients reported mean (SD) RSI and EAT-10 of 19.4 (9) and 8.3 (7.5) accordingly. Postoperatively, patients reported mean (SD) RSI and EAT-10 as 5.4 (6.2) and 2.3 (3.3). Both changes in RSI and EAT-10 were statistically significant (p = 0.008, p = 0.03).
KJD are rare and represent <5% of hypopharyngeal diverticula undergoing surgical intervention. Open transcervical surgery significantly improves symptoms of dysphagia. BAS has high specificity but low sensitivity in detecting KJD.
4 Laryngoscope, 133:2110-2115, 2023.
评估钡餐食管造影（BAS）作为诊断 Killian Jamieson 憩室（KJD）患者的标志物。
对 Prospective OUtcomes of Cricopharyngeus Hypertonicity（POUCH）协作组中登记的个体进行前瞻性、多中心队列研究。从 REDCap 数据库中提取患者人口统计学、合并症、影像学报告、喉镜检查结果、患者报告的结果测量（PROM）和手术报告，并使用平均值、中位数、百分比和频率进行总结。使用配对 t 检验和 Wilcoxon 符号秩检验测试 RSI、EAT-10 和 VHI-10 评分在术前至术后的差异。使用 BAS 检查结果与手术报告比较，计算包括敏感性、特异性、阳性和阴性预测值在内的诊断试验评估，95%置信区间。
共纳入 287 人；13 例（4%）患者的手术报告证实存在 KJD。100%的患者接受了经颈开放性切除术。BAS 在检测 KJD 方面的敏感性为 46.2%（95%置信区间：23.2，70.9），特异性为 97.8%（95%置信区间：95.3，99.0），阳性预测值为 50%（95%置信区间：25.4，74.6），阴性预测值为 97.4%（95%CI：94.8，98.7）。术前，患者报告的 RSI 和 EAT-10 平均值（标准差）分别为 19.4（9）和 8.3（7.5）。术后，患者报告的 RSI 和 EAT-10 平均值（标准差）分别为 5.4（6.2）和 2.3（3.3）。RSI 和 EAT-10 的变化均具有统计学意义（p=0.008，p=0.03）。
KJD 较为罕见，占接受手术干预的咽后憩室的<5%。经颈开放性手术可显著改善吞咽困难症状。BAS 在检测 KJD 方面具有高特异性，但敏感性低。
4 级喉镜检查，133：2110-2115，2023。
