Zenker (Esophageal) Diverticulum

Key Features

• Protrusion of pharyngeal mucosa develops at the pharyngoesophageal junction between the inferior pharyngeal constrictor and the cricopharyngeus

• Loss of elasticity of the upper esophageal sphincter, resulting in restricted opening during swallowing, is believed to be the cause

Clinical Findings

• Dysphagia and regurgitation tend to develop insidiously over years in older predominantly male patients

• Initial symptoms include vague oropharyngeal dysphagia with coughing or throat discomfort

• As the diverticulum enlarges and retains food, patients may note

  • Halitosis

  • Spontaneous regurgitation of undigested food

  • Nocturnal choking

  • Gurgling in the throat

  • Protrusion in the neck

• Complications

  • Aspiration pneumonia

  • Bronchiectasis

  • Lung abscess

Diagnosis

• Video esophagography is the best method to establish diagnosis

Treatment

• Observation is sufficient for small asymptomatic diverticula

• Cricopharyngeal myotomy with incision of the septum between the diverticulum and esophagus is required for symptomatic patients

• Giant diverticula require surgical transcervical myotomy with diverticulectomy