Zenker’s Diverticulum: What is it and How do you Treat it?

Zenker’s Diverticulum is a rare, benign throat disorder seen mainly in elderly people. It is an outpouching that develops in a weakened area at the back of the throat. Although Zenker’s Diverticulum is the most common type of esophageal diverticulum, the true incidence is difficult to determine because so many people with the disorder have no symptoms. Studies have reported statistics showing an annual incidence of 300,000 cases of Zenker’s Diverticulum in the US, meaning it is a disorder affecting less than 1% of the population.

Symptoms of Zenker’s Diverticulum:

Patients with a small Zenker’s Diverticulum may not experience any symptoms. However; symptoms may start to occur, and get worse, as the diverticulum increases in size, causing:

• Difficulty swallowing (dysphagia)
• Regurgitation of Undigested food
• Coughing
• Hoarseness
• Pneumonia caused by aspiration
• Bronchitis
• Food getting into the breathing passages or lungs

Other Symptoms Patient’s with Zenker’s Diverticulum May Experience:

• Pill dysphagia- Pills getting stuck in the throat
• Excess saliva
• Coughing while eating
• Gurgling in throat

Diagnosis of Zenker’s Diverticulum:

Medical History: Focusing on issues such as weight loss, avoidance of eating, difficulty eating including regurgitation or aspiration of food.

Physical Exam: Although a Zenker’s Diverticulum can be 15cm or more, it is rarely felt on physical exam. Diagnosis is achieved through detailed history taking and imaging studies (discussed below).

Imaging Studies: Although endoscopic evaluation is increasingly being used to diagnose esophageal diverticula, the barium swallow is still considered the most effective way to diagnose a Zenker’s diverticulum. The patient is given a barium solution to drink, the solution fills the pouch in the esophageal wall, and it can be seen on an X-ray. This study provides information about the size, location, and character of the mucosal lining of the diverticulum.

Treatment of Zenker’s Diverticulum:

Zenker’s diverticula are normally not treated unless they cause symptoms. These patients are not likely to present themselves, but rather, small diverticula may be incidental findings which usually do NOT require any treatment. A Zenker’s diverticulum which is causing symptoms is usually treated through surgical intervention. In general, the surgeon will cut the muscle between the throat and esophagus and remove the pouch.

Non-Surgical Management of Zenker’s Diverticulum:

In patients with small diverticula ( < 2cm) or those who are unable to physically endure a surgical procedure, non-surgical treatment options such as dilation and botulium toxin MAY be used to alleviate symptoms such as difficulty swallowing. These patients should be monitored as the diverticula is likely to enlarge over time, requiring surgical intervention for definitive treatment.

Surgical Treatment of Zenker’s Diverticulum:

Due to the distress experienced by patients from symptoms of the diverticulum, as well as the risk of aspiration and pneumonia, surgical intervention is recommended for all patients with Zenker’s Diverticulum that are physically able to undergo surgery. The goal of surgical intervention is to alleviate the elevated pressure in the throat and eliminate the diverticular pouch that is acting like a reservoir for food that is being swallowed. The procedure will be performed under general anesthesia for the safety and comfort of the patient. The most common procedure used to surgically treat Zenker’s Diverticulum is cricopharyngeal myotomy, where the cricopharyngeus muscle is cut. This allows the throat to relax, making swallowing easier. Endoscopic cricopharyngeal myotomy is a minimally-invasive surgical approach to treat Zenker’s Diverticulum through the mouth. A laser is used to cut the cricopharyngeus muscle, allowing the pouch to connect to the rest of the esophagus, thus alleviating symptoms.