Center for Minimally Invasive Esophageal Therapies
Diseases & Conditions
At Boston Medical Center we pride ourselves on the ability to diagnose and treat esophageal disorders using the most advanced therapies. We do so in an environment of caring and compassion, in which our priority is the well-being of you and your family.
What is Zenker's Diverticulum?
Zenker's diverticulum (ZD) is a condition characterized by a pouch that develops in the upper esophagus in the neck. The pouch can contain food which can cause difficulty or pain with swallowing and bad breath. Cases of ZD are generally categorized as small, intermediate, or large, depending on the size of the pouch. The condition appears more often in men and women older than 50, and affects men more frequently than women.
Symptoms may include:
- Discomfort with swallowing
- Regurgitation of undigested food hours after eating
- Coughing or the feeling of food sticking in the throat after eating
- Aspirating food or liquid that enters the airway and causes choking or bleeding
- Bad breath
- Unexplained weight loss
The cause is most commonly secondary to increased tension in the muscle at the top of the esophagus (called the cricopharyngeus muscle) causing a functional obstruction.
ZD is generally diagnosed by means of a barium swallow, which is also called a contrast esophagram. For this test, you will drink a barium-containing liquid, which coats the inside of the esophagus and makes its shape and contours appear on x-rays. The x-ray technologist may take a series of images.
Other tests your physician may prescribe for you include:
- Endoscopy. You will be given a relaxing medication intravenously (in a vein) and the surgeon or gastroenterologist will numb the back of your throat and examine the upper esophagus with an endoscope.
- Esophageal manometry. This test measures the pressure inside the lower esophageal sphincter, and may be used if your physician suspects an esophageal movement disorder.
A physical examination and patient history are also important parts of diagnosis.
There are currently no medications to treat ZD. Surgery is the main therapeutic approach; however, some small diverticula do not require treatment. Open and endovascular or transoral repair have both been found to be successful.
For open surgery, an incision is made in your neck and the pouch is removed or tacked upside down so it cannot fill—or it is removed completely. An important part of the operation is to cut the muscle just below the diverticulum to prevent recurrence. Most patients must stay in the hospital for one or two days after the procedure.
In endoscopic repair or transoral repair, a stapling device is inserted through the mouth using metal tubes. The muscle between the pouch and the esophagus is divided, thereby making the pouch part of the upper esophagus. This method does not require an incision, is faster, equally effective and reduces the risk of complications, as well as time in the hospital.
Your physician will work with you to determine the best treatment option, according to your unique situation.