Zenker's Diverticulum

Zenker's diverticulum is caused by a weakness in the muscles of the cervical esophagus (the tube between the mouth and the stomach).

Zenker's diverticulum happens in a very characteristic position in the posterior aspect of the esophagus in the neck.

Symptoms

Symptoms of Zenker's diverticulum include:

• The regurgitation of undigested or recently swallowed food. This can happen at unpredictable times and at different intervals of time from eating
• The development of pneumonia in the setting of food regurgitating into the lungs
• Halitosis

Risk Factors

The risk factors for developing a Zenker's diverticulum are somewhat unknown, but it is proposed that longstanding gastroesophageal reflux may contribute.

Diagnosis

An endoscopy or scope of the esophagus can demonstrate an outpouching in the cervical or neck portion of the esophagus. It occasionally can be difficult to get a endoscope past this diverticulum into the rest of the esophagus. A barium swallow, which is a test where contrast material is swallowed while x-rays are taken, can clearly delineate the size and position of a Zenker's diverticulum.

Treatment

Surgery to correct a Zenker's diverticulum comes in several forms:

• A traditional approach is a small incision in the left neck where the outpouching or diverticulum is removed and the muscle that caused this is opened
• A second approach is a transoral stapling where the common wall between the outpouching in the esophagus is divided
• We also are now working on endoscopic approaches for treatment of Zenker's diverticulum

Most approaches require a one-day admission, although many patients are sent home the same day with the slow advancement of their diet.