March 6, 2010

Zenker's Diverticulum

Lateral view of barium esophagogram shows a large diverticulum (arrow) arising in the midline from the posterior wall of the cervical esophagus (arrowheads).

  • Most common form of esophageal diverticulum
  • Protrusion of mucosa posteriorly just proximal to cricopharyngeus muscle
  • Believed to be due to oropharyngeal discoordination and upper esophageal sphinctor dysfunction
  • Many patients are asymptomatic, but can present with dysphagia, regurgitation, throat discomfort
  • Usually in 5th to 8th decades of life

Diagnosis and Treatment
  • Barium esophagogram is an optimal method to demonstrate the diverticulum
  • Intradiverticular filling defects usually represent food, but carcinoma is in the differential diagnosis.
  • Large diverticulum can present on chest radiograph as a superior mediastinal mass
  • Endoscopy not required, but if it is to be done it should be done with caution because of a risk of inadvertent perforation
  • Treatment: diverticulectomy with or without cricopharyngeal myotoma, endoscopic stapling and division of common wall between cervical esophagus and diverticulum
Grendell JH, et al. Current Diagnosis & Treatment in Gastroenterology, 2nd edition, 2003.

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