From the Research
The most effective treatment for Zenker's diverticulum is transcervical diverticulectomy with cricopharyngeal myotomy, as it has been shown to have a lower likelihood of persistent or recurrent symptoms compared to endoscopic laser-assisted diverticulotomy and stapler-assisted diverticulotomy 1.
Overview of Zenker's Diverticulum
Zenker's diverticulum is a pouch that forms in the upper esophagus, typically occurring in older adults. It develops when the cricopharyngeus muscle fails to relax properly during swallowing, creating increased pressure that causes the esophageal mucosa to herniate through a weak point in the posterior wall. Symptoms include:
- Difficulty swallowing
- Regurgitation of undigested food
- Bad breath
- Chronic cough
- Aspiration pneumonia
Diagnosis and Treatment
Diagnosis is usually made through barium swallow studies or endoscopy. Treatment depends on the size and severity of symptoms. Small, asymptomatic diverticula may require no treatment. For symptomatic cases, surgical options include:
- Endoscopic diverticulotomy, which cuts the muscle between the diverticulum and esophagus
- Open surgical approaches like diverticulectomy with cricopharyngeal myotomy According to the European Society of Gastrointestinal Endoscopy (ESGE), flexible endoscopic treatment is suggested over open surgical treatment as first-line therapy for patients with a symptomatic Zenker's diverticulum of any size 2. However, the most recent and highest quality study suggests that transcervical diverticulectomy with cricopharyngeal myotomy is the most effective treatment option 1.
Management and Prevention
Patients should eat slowly, chew thoroughly, and stay upright after eating to minimize symptoms. If left untreated, complications can include: