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Zenker Diverticulum

A Zenker’s Diverticulum (ZD) is an outpouching that occurs in the esophagus (muscular food pipe that connects the mouth to the stomach). It is thought that high pressure zones in the lumen of the esophagus lead to outpouching formation at a weak point in the top of the esophagus.

Causes

ZD is a rare disease and usually affects men more than women, and often affects those in their 70’s or 80’s. Most ZD does not require therapy if they are not large or do not cause symptoms to the patient. However, progressive enlargement of a ZD can cause symptoms of food getting stuck in the pouch. Patients will experience trouble swallowing, regurgitating food, choking on food, bad breath, weight loss, and chronic coughing.

Treatment

For many years, traditional therapy of ZD has been surgery, where a surgeon would cut into the neck and attempt to cut off the ZD. Surgeons have also used rigid endoscopes (cameras at the end of fiberoptic tubes) to insert them through the mouth, into the esophagus to find and cut the high-pressure zone of the muscle in the esophagus. Open surgery is limited by its invasiveness, recovery time and potential complications. Rigid endoscopic approach may also induce neck trauma and be difficult to perform in elderly patients with neck stiffness.
Therefore, the treatment of ZD has evolved to be performed with a flexible endoscope to cut the high-pressure zone of muscle. Flexible endoscopy avoids the problems and limitations associated with surgical procedures. It has similar success as surgeries and requires shorter procedure and recovery times. Gastroenterologists with special training can use special electrosurgical knives to cut the muscle causing formation of the ZD.

What procedure is performed for ZD?

Patients with ZD undergoing a flexible endoscopic myotomy procedure will be on a liquid diet for about 48 hours prior to the procedure in order to keep the esophagus free of solid food contents. There is no preparation the patients must drink for the ZD procedure. Patients only need to be NPO (not eating/drinking) after midnight prior to the procedure. During the procedure, patients will be sedated with general anesthesia and then admitted to the hospital for an overnight observation. The procedure usually takes about 1 hour, and patients are routinely discharged the following day.

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