Zenker's Diverticulum

Author: Stephanie Worrell, MD
Institution: University of Arizona
Date Reviewed: March 2025
Learning Domain: General Thoracic
Learning Objective: Benign Esophageal Disease
PowerPoint File: File 2023 Zenkers.pptx

 

Case

82-year-old presents with food regurgitation and worsening dysphagia. Spouse comments that patient has terrible breath all the time. 

  • PMH: CAD, PVD, HTN, COPD, GERD
  • Meds: Atorvastatin, HCTZ, Omeprazole, ASA
  • Former smoker, occasional EtOH
  • PE: BP 162/87 HR 84 O2 sat 99% RA
  • Halitosis, Abd soft NTND, Lungs clear to auscultation bilaterally, CV RRR

 

Diagnosis

  • What is in the differential diagnosis?
  • What key imaging or additional work up is needed?
  • What should be ruled out? 

 

Imaging

  • EGD with cervical outpouching, no esophageal mucosal abnormalities and normal appearing stomach
  • Esophagram

     

 

Anatomy

  • False diverticulum of the pulsion type
  • The hypopharyngeal pouch herniates more often to the left, and is rarely seen in the right side of the neck 

 

Treatment Options

  • Transoral endoscopic approaches 
    • Z-POEM, stapler, robotic approach 
  • Transcervical myotomy with diverticulectomy or diverticulopexy

 

Discussion

  • Post-operative management
    • Drain?
    • Diet