May, 2017 zenkers diverticulum is a sac at the bottom of the throat. The etiology of zenker s diverticulum has been a topic of much debate, but increased intraluminal pressure from cp muscle dysfunction is most often implicated. A small zenkers diverticulum can be asymptomatic exhibit no symptoms. Diagnostic testing o laboratory evaluation little or no value. It represents 70% of all cases of diverticula, followed by traction diverticula 20% and epiphrenic diverticula 10%. Zenker s diverticulum is a rare, benign throat disorder seen mainly in elderly people. Affected individuals may suffer from longstanding swallowing difficulties dysphagia, regurgitation, bad breath, weight loss, and even aspiration the passage of food or other hazardous material into the lungs. Initial treatment is focused on a reduction of immunosuppression. Zenkers diverticulum symptoms, diagnosis, treatments and. Flexible endoscopic and surgical management of zenkers. Zenker s diverticulum, is a diverticulum of the mucosa of the pharynx, just above the cricopharyngeal muscle.
Dysphagia after endoscopic repair of zenkers diverticulum article pdf available in the laryngoscope 1174. It is a rare disease typically seen in the middleaged and older adults. Learn vocabulary, terms, and more with flashcards, games, and other study tools. More detailed information about the symptoms, causes, and treatments of zenker s diverticulum is available below. Symptoms include dysphagia, regurgitation, halitosis, postprandial vomitus and cough.
A septum between the diverticulum and the lumen of the esophagus can develop and hamper the passage of food. Larger, symptomatic cases of zenkers diverticulum have been traditionally treated by neck surgery to resect the diverticulum and incise the cricopharyngeus muscle. Zenkers diverticulum zd is a saclike outpouching of the lining of the esophageal wall at the upper esophagus. Zenkers diverticulum is a pseudodiverticulum of the esophagus that forms in the killians triangle, between the inferior pharyngeal constrictor and the cricopharyngeus cp muscle. As the pouch enlarges and dysphagia increases, symptoms become more severe with resultant weight loss. Distinguish the best imaging modality to diagnose zenkers diverticulum. Zenkers diverticulum and other esophageal diverticula. It can be asymptomatic or cause dysphagia and regurgitation. Larger, symptomatic cases of zenker s diverticulum have been traditionally treated by neck surgery to resect the diverticulum and incise the cricopharyngeus muscle. Dysphagia that is the result of persistent cricopharyngeal spasm andor a zenker s diverticulum is particularly amenable to surgical correction. Zenkers diverticulum an overview sciencedirect topics.
When food and saliva fill up the pouch, however, symptoms can occur and may include. Zenker s diverticulum zd is a saclike outpouching of the mucosa and submucosa through killian s triangle, an area of muscular weakness between the transverse fibers of the cricopharyngeus muscle and the oblique fibers of the lower inferior constrictor ie, thyropharyngeus muscle figure 1. It is a pulsion diverticulum that is likely the result of poor coordination between the pharyngeal and upper esophageal sphincter contractions at an area of anatomical weakness. This indicates that the cricopharyngeus plays a central pathophysiological role in giving rise to the condition 1, 3 5 and suggests that the treatment of zenkers diverticulum should always. Presently, there arent any medications yet that treats the condition and if you leave the condition untreated, youll continue to have trouble swallowing which can cause malnutrition, weight loss or pneumonia. Sometimes, other conditions are present alongside zenker s. Zenkers diverticulum is a rare, benign throat disorder seen mainly in elderly people. A zenkers diverticulum, more formally known as a hypopharyngeal diverticulum, is a pouch that can form at the junction of the hypopharynx lower part of the throat and the esophagus, an area known as killians triangle.
The main cause of zenkers diverticulum is thought to be malfunctioning of the cricopharyngeal muscle due to the aging process. Another patient had total dysphagia of 3 days duration because of food impaction in the zenker s diverticulum along with intense dehydration with hypotension and mental confusion. Endoscopic treatment of zenkers diverticulum sciencedirect. The surgery is designed to release the tightened cricopharyngeal muscle, often in conjunction with removal of the zenker s diverticulum sac. Zenkers diverticulum zd is an uncommon but highly treatable cause of dysphagia. Zenkers diverticulum uc davis center for voice and. The condition goes by several names, depending on the location of the pouch. Assess the clinical presentation of zenkers diverticulum. Pdf principles of surgical treatment of zenker diverticulum.
Dysphagia, odynophagia, and regurgitation are seen in the. A barium swallow is a special xray that highlights the inside of your mouth, pharynx, and esophagus. Zenkers diverticulum zd is an outpouching of tissue through the killian triangle that is believed to be caused by dysfunction of the cricopharyngeal muscle. Endoscopic treatment of zenkers diverticulum springerlink. Esophageal diverticula gastrointestinal disorders merck manuals. Most often found in individuals over the age of 50 but possible at even younger ages, zenkers diverticulum is a disorder of the throat in which a diverticulum, a pouch, develops in the throat wall. The pathophysiology of zenker s diverticulum, clinical presentation, and.
It often appears in the elderly, usually over 70 years of age. Endoscopic treatment for zenkers diverticulum is safe longterm. A new study reports that flexible endoscopic treatment of zenker s diverticulum by using a diverticuloscope offers a treatment modality with a very low complication rate. Food may accumulate in the pouch, causing it to fill and at times regurgitate up. Although zenker s diverticulum is the most common type of esophageal diverticulum, the true incidence is difficult to determine because so many people with the disorder. Endoscopic laserassisted diverticulotomy versus open surgical approach in the treatment of zenker s diverticulum.
Zenker s diverticulum is a rare disease, which can cause considerable suffering. Zenkers diverticulum zd, also known as cricopharyngeal, pharyngoesophageal or. An esophageal diverticulum is a pouch that protrudes outward in a weak portion of the esophageal lining. Zenkers diverticulum, is a diverticulum of the mucosa of the pharynx, just above the cricopharyngeal muscle.
Baron also discusses traditional surgical management, as well as. A zenkers diverticulum is a pouch that forms at the end of the throat and the beginning of the esophagus the swallowing tube. The pathophysiology of zenkers diverticulum, clinical presentation, and. Symptoms of esophageal diverticula dysphagia and regurgitation. Zenkers diverticulum location, symptoms, treatment, diet. Furthermore, signs and symptoms of zenkers diverticulum may vary on an individual basis for each patient. Endotherapy of zenker s diverticulum using the needleknife technique. The objective of an excision of zenker s diverticulum is not only to remove the diverticulum, but to release the malfunctioning muscle of the throat the cricopharyngeus cp muscle. It has been known that the best option for this condition is to do nothing. All patients with zenkers diverticulum will swallow better following treatment of the zenker s diverticulum.
Over a lifetime of swallowing, when there is excessive pressure within the lower portion of the pharynx the back wall of the throat, the weakest portion of the pharyngeal wall balloons out. Patients with a zenker s diverticulum experience symptoms when food or secretions get stuck in the pouch. A new treatment for zenkers diverticulumsubmucosal. Zenkers diverticulum is a pouch at the back of the throat at a weak spot where the throat and esophagus join. A condition that progressively worsens over time, esophageal diverticulum most often strikes adults over 60 years of age. Zenkers diverticulum zd, or pharyngeal pouch, is an anatomical defect. More detailed information about the symptoms, causes, and treatments of zenkers diverticulum is available below.
The results with number and type of complications in 274 endoscopically treated patients including 6 patients with a recurrent diverticulum after transcutaneous surgery are reported. New and emerging techniques for endoscopic treatment of zenkers. Zenkers diverticulum southern california, orange county. Apr 27, 2017 the main cause of zenkers diverticulum is thought to be malfunctioning of the cricopharyngeal muscle due to the aging process. This shall only warrant for an intervention when it has come to a point of disability to the client. Because the bottom of the pouch is lower than the opening into the throat, secretions and food particles build up in the pouch. Predominant symptoms are dysphagia and regurgitation.
For submission instructions, please see the gastroenterology web site. The predominant symptom of zd is dysphagia, and the most serious consequence is pulmonary aspiration. Common symptoms of the disease include difficulties in swallowing dysphagia, food reflux regurgitation, unpleasant breath smells halitosis and couch. The only treatment to cure zenkers diverticulum is a surgical intervention, which relieves symptoms and improves the quality of life. Introduction dysphagia is the sensation that swallowing is difficult or impossible.
A new study reports that flexible endoscopic treatment of zenkers diverticulum by using a diverticuloscope offers a treatment modality with a very low complication rate. Zenker s diverticulum is a pouch at the back of the throat at a weak spot where the throat and esophagus join. Evaluation and treatment of zenkers diverticulum springerlink. Zd is a relatively uncommon disorder occurring in the elderly. This pouch typically causes problems by trapping food as it is being swallowed, leading to choking and aspiration. Patients with this condition often exhibit no symptoms. This pocketlike structure can appear anywhere in the esophageal lining between the throat and stomach. Zenkers diverticulum is a rare disease, which can cause considerable suffering. Apr 30, 20 a new study reports that flexible endoscopic treatment of zenker s diverticulum by using a diverticuloscope offers a treatment modality with a very low complication rate. Esophageal diverticula pleural of diverticulum are classified by their location within the esophagus. Preoperative assessment using fiberoptic endoscopic evaluation of swallowing demonstrated that postswallow hypopharyngeal reflux was predictive of a diverticulum larger than 1 cm and may be useful in surgical planning. Therapy of zenkers diverticulum pubmed central pmc. Transoral endoscopic excision of zenkers diverticulum.
Although zenkers diverticulum is the most common type of esophageal diverticulum, the true incidence is difficult to determine because so many people with the disorder. It is a pouch that forms in your pharynx, an area just above your esophagus or swallowing tube. This signs and symptoms information for zenkers diverticulum has been gathered from various sources, may not be fully accurate, and may not be the full list of zenkers diverticulum signs or zenkers diverticulum symptoms. This happens when there is pressure on your pharynx and it balloons out. Zenkers diverticulum surgery method l cervical incision, vertical myotomy several cm on either side of base of diverticulum, remove or suspend diverticulum, leave drains postop cricopharyngeal myotomy. Dysphagia that is the result of persistent cricopharyngeal spasm andor a zenkers diverticulum is particularly amenable to surgical correction.
Dysphagia difficulty swallowing regurgitation return of undigested food back into the mouth sense of a lump in the neck. When this muscle is cut the throat relaxes, making swallowing easier. Zenkers diverticulum is a sac at the bottom of the throat. The word derives from the greek roots dys, which means difficulty, and phago, which means to eat. It is most likely as a result of increased intraluminal pressure and tissue degeneration. Upon completion of this activity, participants will be able to.
Zenker s diverticulum surgery method l cervical incision, vertical myotomy several cm on either side of base of diverticulum, remove or suspend diverticulum, leave drains postop cricopharyngeal myotomy. Difficulty swallowing dysphagia, often with a feeling of a lump in your throat. This signs and symptoms information for zenker s diverticulum has been gathered from various sources, may not be fully accurate, and may not be the full list of zenker s diverticulum signs or zenker s diverticulum symptoms. These diverticula are uncommon and tend to occur in elderly people. The effectiveness of myotomy of the cricopharyngeus as the sole treatment of zenkers diverticulum has been demonstrated in multiple studies. Show full abstract a zenker s diverticulum in 75 years old sudanese man with a chronic history of dysphagia for solids. The reappearance of ingested food regurgitation in your mouth when food becomes trapped in the outpouching.
Pharyngeal zenker s diverticulum is a disorder of upper. Fibreoptic diverticular repair is another of the methods for treating zenkers diverticulum. May 25, 2017 the only treatment to cure zenkers diverticulum is a surgical intervention, which relieves symptoms and improves the quality of life. Zenkers diverticulum a sac or pouch in the back of the throat which causes difficulty swallowing by collecting and retaining food and saliva. Pdf pharyngoesophageal diverticula are most frequently described in elderly patients, having symptoms such as dysphagia, regurgitation, chronic. Treatment for zenkers diverticulum is aimed in alleviating the presenting symptoms of the client.
When a person swallows, the muscle at the top of the esophagus is supposed to open. These are usually first noted during the 5 th to 7 th decade of life. Zenkers diverticula are more common in men than women and usually present in persons over 60 years of age. Endoscopic stapling technique for the treatment of zenker. When a diverticulum increases in size, the following symptoms may appear. Furthermore, signs and symptoms of zenker s diverticulum may vary on an individual basis for each patient. Zenkers diverticulum zd results from posterior herniation of esophageal mucosa into killians triangle, an area of least resistance situated above the cricopharyngeus cp muscle and below the inferior pharyngeal constrictor muscle. Zenker s diverticulum is a pseudodiverticulum of the esophagus that forms in the killian s triangle, between the inferior pharyngeal constrictor and the cricopharyngeus cp muscle. Jun 18, 2014 dysphagia characteristics in zenkers diverticulum.
The results obtained seem to confirm that endoscopic treatment of a hypopharyngeal diverticulum is to be preferred to an. Pdf nursing approach to zenkers diverticulum surgery patient. Todd baron defines zenker s diverticulum and its symptoms. Baron also discusses traditional surgical management, as well as endoscopic treatment of zenker s diverticulum. Upper endoscopy revealed a small zenkers diverticulum as well as another. Zenker diverticulum diverticula esophago pharyngeal. Zenkers diverticulum tough to swallow cornerstone ear. Zenker diverticulum is a term describing the herniation of the mucosal and submucosal layers of the pharynx through the cricopharyngeus muscle at the pharyngoesophageal junction. The surgery is designed to release the tightened cricopharyngeal muscle, often in conjunction with removal of the zenkers diverticulum sac. It is more prevalent in men than in women and typically presents in the seventh and eighth decades of life. The goal of this activity is to evaluate the diagnosis and management of zenkers diverticulum. However, in recent times nonsurgical endoscopic techniques have gained more importance as they allow for much faster recovery, and the currently preferred treatment is endoscopic.
Show full abstract a zenkers diverticulum in 75 years old sudanese man with a chronic history of dysphagia for solids. Anatomically there is a loose bulge of the dorsal wall of the hypopharynx. Feb 15, 2008 the effectiveness of myotomy of the cricopharyngeus as the sole treatment of zenkers diverticulum has been demonstrated in multiple studies. Is a swelling or pulsion that forms at the back of the throat at the junction of the pharynx and esophagus in older. Another patient had total dysphagia of 3 days duration because of food impaction in the zenkers diverticulum along with intense dehydration with hypotension and mental confusion. Koch m, mantsopoulos k, velegrakis s, iro h, zenk j. After resuscitation a first endoscopic procedure was performed to withdraw the remains of food from the diverticulum and to introduce a nasogastric tube. Halitosis smelly breath due to stagnant food in the pouch. The etiology of zenkers diverticulum has been a topic of much debate, but increased intraluminal pressure from cp muscle dysfunction is most often implicated. Zenkers diverticulum zd is a saclike outpouching of the mucosa and submucosa through killians triangle, an area of muscular weakness between the transverse fibers of the cricopharyngeus muscle and the oblique fibers of the lower inferior constrictor ie, thyropharyngeus muscle figure 1.
Dysphagia after endoscopic repair of zenkers diverticulum. The results obtained seem to confirm that endoscopic treatment of a hypopharyngeal diverticulum is to be preferred to an external. It is an outpouching that develops in a weakened area at the back of the throat. The technique of endoscopic treatment of hypopharyngeal diverticula is described. Zenker s diverticulum zd is a saclike outpouching of the lining of the esophageal wall at the upper esophagus. A barium swallow fluoroscopy allows your doctor to see how you swallow in motion.
Zenker diverticulum zd is a specific type of esophageal diverticulum that results in herniation of esophageal mucosa from an area of muscular weakness, also known as killian dehiscence, located between the inferior aspect of the inferior constrictor muscle and the cricopharyngeus cp muscle and is a common problem facing the head and neck surgeon. Strictures, zenkers diverticulum, neoplasms, and dysphagia red flags. Todd baron defines zenkers diverticulum and its symptoms. Jun 18, 2014 vogelsang a, preiss c, neuhaus h, et al. Zenker s diverticulum is diagnosed using a test called a barium swallow. Treatment is recommended for symptomatic patients and considering the aetiopathogenesis of the. The treatment for a zenkers diverticulum is cutting the cricopharyngeus muscle, known as a cricopharyngeal myotomy. Zenkers diverticulumcausessymptomstreatmentdiagnosis. Zenkers diverticulumendoscopic staple diverticulostomy esd. The most common form, zenkers diverticulum is found at the level of the lower neck and usually at the back of the throat. When a person swallows, the muscle at the top of the esophagus is supposed to open, and the food should flow through the esophagus.
Dysphagia in a patient with a zenkers diverticulum. Materials and methods patients and controls we studied 14 consecutive patients 9 male, 5 fe. Zenkers diverticulum zd or pharyngeal pouch is a rare esophageal disorder with an annual incidence of just 2 per 100,000. Endoscopic laserassisted diverticulotomy versus open surgical approach in the treatment of zenkers diverticulum. Endoscopic stapling is the currently preferred treatment for zenkers diverticulum, i. Endoscopic treatment for zenkers diverticulum is safe long. Zenkers diverticulum and swallowing disorders treatment. Zenkers diverticulum repair what is zenkers diverticulum. Endotherapy of zenkers diverticulum using the needleknife technique.
842 552 472 1024 1342 891 297 1081 53 450 1624 1148 1211 1553 71 555 1271 702 1597 1418 598 1380 1412 977 694 642 815 661 166 99 1391 364 1448 784 485 1472 31 1 1140 1228