Overview
Zenker's diverticulum is a pharyngeal diverticulum typically located in the posterior hypopharynx, characterized by the herniation of mucosa through a weakness in the muscular wall, leading to symptoms such as dysphagia, regurgitation, and aspiration 1.Diagnosis
Clinical symptoms including dysphagia, halitosis, and regurgitation
Imaging studies (barium swallow, CT, MRI) to confirm diagnosis and assess size and complications
Endoscopy for direct visualization and to rule out malignancy 2Management
First-line treatment: Endoscopic diverticulostomy or flexible endoscopic cricopharyngeal myotomy/septotomy under sedation or general anesthesia 12
Adjunctive treatments: Hybrid endoscopic approaches or open diverticulectomy for recurrent or complex cases 2Special Populations
Elderly: Flexible endoscopic techniques are feasible but require careful assessment of comorbidities and procedural risks 2
Comorbidities: Patients with significant comorbidities may benefit from less invasive endoscopic approaches to minimize surgical risks 2Key Recommendations
Endoscopic diverticulostomy should be considered the preferred first-line surgical approach for Zenker's diverticulum due to its efficacy and lower invasiveness (Evidence: Strong 1).
Flexible endoscopic techniques, including myotomy/septotomy, offer effective short-term relief with reasonable long-term outcomes, though recurrent symptoms may necessitate retreatment (Evidence: Moderate 2).
For patients experiencing recurrent symptoms post-endoscopic intervention, a stepwise approach including repeat endoscopic procedures, hybrid techniques, or open surgery should be considered based on individual patient factors (Evidence: Expert opinion 2).References
1 Johnson CM, Postma GN. Zenker Diverticulum--Which Surgical Approach Is Superior?. JAMA otolaryngology-- head & neck surgery 2016. link
2 de la Morena Madrigal EJ, Pérez Arellano E, Rodríguez García I. Flexible endoscopic treatment of Zenker's diverticulum: thirteen years' experience in Spain. Revista espanola de enfermedades digestivas 2016. link