A diverticulum is a pouch that occurs anywhere along the esophagus or intestine. A Zenker’s diverticulum (ZD) is a pouch that occurs near the top of the esophagus. It forms because the muscular ring (sphincter) at the top of the esophagus is too tight. Pressure that develops at the back of the throat during initiation of a swallow pushes on the walls of the throat over time and forms a pouch. Patients with a ZD present with difficulty swallowing. Food and saliva catch in the pouch, which is often regurgitated after meals or even the next day. As the pouch gets bigger, weight loss becomes a problem as food preferentially fills the pouch instead of the stomach. Many patients also have mild hoarseness. Most patients with a ZD are elderly (80s), however these can occur in patients in middle age (40s).
The treatment of ZD can be performed either through a neck incision (open excision) or endoscopically through the mouth. Depending on the size of the pouch and the frailty of the patient, options may vary. Many patients prefer the endoscopic approach because of its simplicity, effectiveness, and minimal risk of complications. There is a risk of recurrent symptoms with either of these procedures and this often sways patients to consider the least invasive approach. Both of these options are available for our patients.