LAUSR

Siau et al. raise some interesting points regarding the results of the use of the SWAL-QOL questionnaire for the assessment of swallowing-related quality of life after endoscopic treatment for Zenker’s diverticulum (ZD) [1]. First, the notice of the fact that SWAL-QOL does not address the symptom of regurgitation should indeed be regarded as a limitation of its use for the evaluation of this particular symptom in ZD patients both at baseline as well as during follow-up after ZD treatment. Potentially, this shortcoming might lead to a validated modification of SWAL-QOL and/or other questionnaires towards a more ZD-oriented tool. In fact, this would envisage some modifications in terms of adding questions related to regurgitation. As this complaint, also in our study [1], is a common symptom in ZD patients (48% combining dysphagia and/or regurgitation as their main complaint) at presentation, this is indeed highly relevant. In addition, as clearly pointed out by Siau et al., relapse of this specific complaint might usually suggest ZD recurrence [2]. In our study, due to the short follow-up time, this was not an issue. Similarly, Skaug et al. added two questions specific to dysphagia (regurgitation and nightly mucus production) at the MD Anderson Dysphagia Inventory (MDADI) in order to make this dysphagia questionnaire more specific for patients with ZD [3]. Second, we believe that the high rates of participant’s non-engagement (37.5%) in our study is not mainly due to the relatively long time needed to fill out SWAL-QOL questionnaire, but rather due to the high age-related prevalence of ZD cohorts (mean age being 69 years in the present trial, and in other studies ranging from 68 up to 82 years [4, 5]), and the unwillingness and/or the potential difficulty to work with the computer. Another important aspect of our present trial is that the main goal of the authors was to assess and estimate mean SWAL-QOL baseline values in ZD patients seeking treatment. In addition, we were able to report on changes in SWAL-QOL values after endoscopic ZD treatment over a short postoperative follow-up period of 3 months on average. This follow-up in the present study is too short to draw conclusions on the role of SWAL-QOL in detecting ZD relapse, as previous studies have indicated that recurrence rate would occur over a median time of 7–43 months [5]. The role of the SWAL-QOL questionnaire in long-term follow-up of endoscopic treatment of ZD is currently the subject of ongoing and future clinical trials. In other words, the present study was neither aiming to evaluate the role of SWAL-QOL in the long-term follow-up nor planning to detect ZD recurrences because of the short-term assessment.