Zenker’s Diverticulum - SP Medifort Hospital

Zenker’s Diverticulum Treatment

Zenker’s Diverticulum Disease

Zenker’s diverticulum is an abnormal pouch or outpouching that forms at the top of the esophagus (the tube that carries food from your throat to your stomach). It develops just above the upper esophageal sphincter (cricopharyngeus muscle) and can trap food, liquids, and saliva, leading to swallowing problems.

Symptoms and Causes

What are the symptoms of Zenker’s Diverticulum?

Symptoms may include:

Regurgitation of undigested food.
Bad Breath (halitosis).
Difficulty Swallowing (dysphagia).
Choking.
Coughing.
Weight Loss.
Hoarseness.
Burping.

What causes Zenker’s Diverticulum?

A healthcare provider will review your symptoms and often use imaging tests to confirm Zenker’s diverticulum, which helps visualize the abnormal pouch and how your swallowing works.

Upper Esophageal Muscle Dysfunction: The muscle that should relax to let food pass into the esophagus (cricopharyngeus) doesn’t open properly during swallowing. This leads to pressure buildup above it, causing the inner lining to bulge out and form a pouch.
Increased Swallowing Pressure: Powerful swallowing muscles push food downward against a tight upper sphincter, creating extra force on a weak area of the throat wall and contributing to the outpouching.
Age-Related Changes: The condition is more common in older adults, likely because muscle tone and coordination in the throat and esophagus decline with age.
Associated swallowing disorders: Conditions like esophageal motility problems or reflux-related dysfunction may further disrupt normal swallowing mechanics and promote pouch formation.

Diagnosis of Zenker’s Diverticulum

Zenker’s diverticulum is diagnosed mainly with imaging tests that show how swallowing works.

Barium Swallow (Esophagram): This is the gold standard test. The patient drinks a liquid containing barium, and X-ray images are taken while swallowing. It clearly shows the pouch (diverticulum) forming at the back of the throat.
Upper Endoscopy: A thin, flexible tube with a camera is passed down the throat to directly view the inside of the esophagus and the opening of the diverticulum, aiding confirmation and assessment.

What are the Zenker’s Diverticulum risk factors?

Risk factors for Zenker’s diverticulum include:

Older Age: Most commonly occurs in people over 60 due to age-related muscle weakness.
Gender: More frequent in men than women.
Cricopharyngeal Muscle Dysfunction: Poor relaxation of the upper esophageal sphincter increases pressure during swallowing.
Chronic Swallowing Disorders: Long-standing dysphagia raises intrapharyngeal pressure.
Gastroesophageal Reflux Disease (GERD): Repeated irritation may contribute to muscle dysfunction.

What treatment options are available for Zenker’s Diverticulum?

Treatment of Zenker’s diverticulum is individualized and depends on the size of the diverticulum, severity of symptoms, patient age, and overall surgical risk.

Observation: Small, asymptomatic diverticula do not require immediate intervention and can be managed with regular follow-up and symptom monitoring.

Endoscopic Stapling (rigid endoscopic diverticulotomy): A minimally invasive approach that divides the common wall between the esophagus and diverticulum, allowing food to pass freely and reducing pouch formation.

Flexible Endoscopic Diverticulotomy: Performed using a flexible endoscope with laser or electrocautery, making it especially useful in elderly or high-risk patients who may not tolerate open surgery.

Open Surgical Diverticulectomy: Involves excision of the diverticulum along with cricopharyngeal myotomy and is reserved for large diverticula or when endoscopic methods are not suitable.

Cricopharyngeal Myotomy Alone: Used in selected cases with small diverticula, aiming to relieve upper esophageal sphincter dysfunction and prevent progression.