Zenker’s Diverticulum: Symptoms, Causes, Treatment in Dallas (Z-POEM)

Zenker’s Diverticulum: Symptoms, Causes, Treatment in Dallas; refers to an abnormal, pouch-like structure. Diverticula can form in almost any area of the digestive tract. It is an abnormal, pouch-like structure that forms at the junction of the pharynx and esophagus.

Zenker’s diverticulum is also referred to as pharyngoesophageal diverticulum, hypopharyngeal diverticulum, or pharyngeal pouch.

It typically appears in the hypopharynx (the bottommost part of the pharynx).

It is a rare condition that affects between 0.01 and 0.11 percent of the world’s population. It occurs mostly in older people in their 70s and 80s. It is also more common in men than in women.

Causes of Zenker’s Diverticulum

Coordination of the muscles in the mouth, pharynx, and esophagus are all involved during swallowing of foods. When swallowing food, the upper esophageal sphincter opens up to allow food to pass through into your stomach. After swallowing the food, the upper esophageal sphincter closes to prevent air from entering into the esophagus.

When the upper esophageal sphincter doesn’t open very well, it exerts pressure on an area of the pharynx wall. This pressure gradually pushes the tissue outward and causes it to form the diverticulum.

Symptoms of Zenker’s Diverticulum

The most common symptom of Zenker’s diverticulum is difficulty in swallowing.

Other symptoms of Zenker’s diverticulum include:

• Regurgitating food or drinks
• Bad breath
• Hoarse voice
• Persistent cough
• Swallowing liquids or food down the wrong pipe
• Sensation of a lump in your throat

Diagnosis of Zenker’s Diverticulum

Your doctor may order some diagnostic tests to ascertain the severity and cause of the Zenker’s diverticulum. Diagnostic tests that your doctor may order include:

Barium swallow 

This is a diagnostic test whereby you will be given barium prepared in liquid form to swallow. A special X-ray is then used to view the inside of your mouth, pharynx, and esophagus. A barium swallow with an X-ray allows your doctor to see the movement of your esophagus as you swallow.

Upper endoscopy

An upper endoscopy is a procedure that involves using a thin, camera-equipped endoscope to view the inside of the throat and esophagus.

Esophageal manometry

This is a test performed to measure the pressure inside your esophagus.

Treatment of Zenker’s Diverticulum

If left untreated, symptoms of Zenker’s diverticulum can get worse over time.

Treatment options include:

Changing your eating habits

Changing your eating habits can sometimes help improve symptoms of Zenker’s diverticulum. Eat smaller quantities of food and chew thoroughly before swallowing. Drink more water and liquids between bites.

Endoscopy

During an endoscopy, a surgeon inserts an endoscope into your mouth. A light and camera are attached to the top of the endoscope. An incision is made in the wall that separates the diverticulum from the lining of the esophagus using the endoscope.

Endoscopy can be rigid or flexible. A rigid endoscopy uses an unbendable endoscope. It requires general anesthesia and requires significant neck extension.

Rigid endoscopy is not recommended for people who have a small diverticulum, a high body mass index, or difficulty extending their neck.

A flexible endoscopy uses a bendable endoscope. It can be performed without general anesthetic. It is an outpatient procedure and carries a lower risk of complications than rigid endoscopy.

Zenker’s diverticulum may reoccur after flexible endoscopy. For this reason, multiple flexible endoscopy procedures may be performed to address recurring of Zenker’s diverticulum.

Open surgery

An open surgery may be the next option when endoscopy isn’t possible or when the Zenker’s diverticulum is very large.

During the surgery, the surgeon will make a small incision in your neck and perform a diverticulectomy by separating the diverticulum from the esophageal wall. The surgeon may perform a diverticulopexy or a diverticular inversion by changing the position of the diverticulum and sewing it in place in some other cases.

Open surgery is performed under general anesthetic. You will need to remain in the hospital for several days after the surgery. You may need to use a feeding tube for about a week or more after the surgery. This is because you will be unable to chew food immediately after the surgery. Your doctor may also suggest a special diet during your recovery.

Open surgery has a high success rate. Symptoms of Zenker’s diverticulum are unlikely to reappear in the long term.

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