A Zenker’s diverticulum (ZD) is an anatomic outpouching of the esophagus (food pipe) that typically occurs in elderly patients in the 7th or 8th decade of life. ZD is thought to be caused by a high-pressure muscle zone in the upper esophagus that results in an outpouching.
A ZD can result in difficulty swallowing liquids, pills and solid foods. It can even result in symptoms of choking and aspiration. The reason this happens is the food and liquids often will get stuck or caught in a ZD as opposed to traveling normally down the esophagus into the stomach. The retention of food and liquid and even pills in a ZD can cause distressing symptoms of regurgitation, choking or feeling of food stuck in the throat. Some patients may even develop bad breath from this problem.
Traditionally, treatment for ZD has required head and neck surgery to dissect the muscle or even remove the diverticulum. This is a relatively higher risk procedure because a surgeon has to dissect through the neck and avoid major vascular, nerve and muscular structures.
However, now cutting of the high-pressure muscle is now possible endoscopically without the need for surgical dissection in to the neck. Endoscopists can use specialized cautery-enhanced knives to access the muscular septum of the ZD from inside the esophagus and cut it to remodel the esophagus. Multiple studies have shown that that endoscopic therapy is a highly effective with little recovery time.
Generally the endoscopic approach to treating ZD is reserved for patients with smaller sized ZD on the order of a few cm. Larger ZD may not respond as well to endoscopic approaches. ZDs may increase in size over time, thus endoscopic therapy may be applicable to those patients in the earlier course of their disease.
If you are having an endoscopic ZD myotomy, you will receive instructions from your doctor about how to prepare for the appointment. All patients undergoing this procedure will receive anesthesia so as not to feel any pain or remember the procedure. During the procedure the doctor will pass an endoscope (a flexible tube with camera and lights) into the mouth to the level of the ZD and use specialized endoscopic knives to cut the diseased muscle. ). Generally patients will stay in the hospital one night after the procedure for monitoring.
Are you interested in learning more about Zenker’s Diverticulum Myotomy, or other treatment options? We invite you to contact us to learn more. Dr. Prashant Kedia is a therapeutic endoscopist and gastroenterologist serving patients in the Dallas-Fort Worth area and beyond. Call today to schedule an appointment at (214) 941-6891.