Zenker's diverticulum
| Zenker's diverticulum | |
|---|---|
| Specialty | Gastroenterology  |
In anatomy, Zenker's diverticulum, also pharyngoesophageal diverticulum, also pharyngeal pouch, is a diverticulum of the mucosa of the pharynx, just above the cricopharyngeal muscle (i.e. above the upper sphincter of the esophagus). It is a false diverticulum (not involving all layers of the esophageal wall).
It was named in 1877 by German pathologist Friedrich Albert von Zenker.[1][2]
Epidemiology
Zenker's diverticulum mainly affects older adults.
Mechanisms and manifestations
In simple words, when there is excessive pressure within the lower pharynx, the weakest portion of the pharyngeal wall balloons out, forming a diverticulum which may reach several centimetres in diameter.
More precisely, while traction and pulsion mechanisms have long been deemed the main factors promoting development of a Zenker's diverticulum, current consensus considers occlusive mechanisms to be most important: uncoordinated swallowing, impaired relaxation and spasm of the cricopharyngeus muscle lead to an increase in pressure within the distal pharynx, so that its wall herniates through the point of least resistance (variously known as Killian's triangle, Laimer's triangle, and the Killian-Laimer triangle). The result is an outpouching of the posterior pharyngeal wall, just above the oesophagus, specifically just above the cricopharyngeal muscle.[3]
While it may be asymptomatic, Zenker diverticulum often causes clinical manifestations such as dysphagia (difficulty swallowing), and sense of a lump in the neck; moreover, it may fill up with food, causing regurgitation (reappearance of ingested food in the mouth), cough (as some food may be regurgitated into the airways), halitosis (smelly breath, as stagnant food is digested by microrganisms), potential infection of the pharyngeal areas due to food stuck, and involuntary gurgling noises when swallowing. It rarely, if ever, causes any pain.
Cervical webs are seen associated in 50% patients with this condition.
Diagnosis
A simple barium swallow will normally reveal the diverticulum. Endoscopy should not be performed due to the risk of perforating the diverticulum.
Treatment
If small and asymptomatic, no treatment is necessary. Larger, symptomatic cases of Zenker's diverticulum have been traditionally treated by neck surgery to resect the diverticulum and incise the cricopharyngeus muscle. However, in recent times non-surgical endoscopic techniques have gained more importance (as they allow for much faster recovery), and the currently preferred treatment is endoscopic stapling[4][5] (i.e. closing off the diverticulum via a stapler inserted through a tube in the mouth). This may be performed through a fibreoptic endoscope.[6]
Other non-surgical treatment modalities exist, such as endoscopic laser, which recent evidence suggests is less effective than stapling.[7]
References
- ^ synd/2461 at Who Named It?
- ^ F. A. Zenker and Hugo Wilhelm von Ziemssen. Krankheiten des Oesophagus. Leipzig, 1867.
- ^ van Overbeek JJ (2003). "Pathogenesis and methods of treatment of Zenker's diverticulum". Ann. Otol. Rhinol. Laryngol. 112 (7): 583–93. PMID 12903677.
{{cite journal}}: Unknown parameter|month=ignored (help) - ^ Sen P, Bhattacharyya AK (2004). "Endoscopic stapling of pharyngeal pouch". J Laryngol Otol. 118 (8): 601–6. doi:10.1258/0022215041917817. PMID 15453934.
{{cite journal}}: Unknown parameter|month=ignored (help) - ^ Chang CY, Payyapilli RJ, Scher RL (2003). "Endoscopic staple diverticulostomy for Zenker's diverticulum: review of literature and experience in 159 consecutive cases". Laryngoscope. 113 (6): 957–65. doi:10.1097/00005537-200306000-00009. PMID 12782805.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ Altman JI, Genden EM, Moche J (2005). "Fiberoptic endoscopic-assisted diverticulotomy: a novel technique for the management of Zenker's diverticulum". Ann. Otol. Rhinol. Laryngol. 114 (5): 347–51. PMID 15966520.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ Miller FR, Bartley J, Otto RA (2006). "The endoscopic management of Zenker diverticulum: CO2 laser versus endoscopic stapling". Laryngoscope. 116 (9): 1608–11. doi:10.1097/01.mlg.0000233508.06499.41. PMID 16954989.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link)