Zenker's Diverticulum: Frequently Asked Questions

by , last modified on 4/14/21.


What is a Zenker’s diverticulum? (Click here to jump down to questions about treatment)

Zenker’s diverticulum is a pouch that forms at the back of the throat at the junction of the pharynx and the esophagus (the food passage to the stomach). The pouch causes problems with swallowing. In the image to the right, the arrow is pointing to the pouch.

Who gets a Zenker’s diverticulum?

Zenker's diverticulum is most common in people over the age of 60. However, we have seen patients in their 30’s who have Zenker’s diverticulum.

What causes Zenker’s diverticulum?

The cause of Zenker’s diverticulum is not precisely known, though there are several hypothesis researchers have conjectured about. Some thoughts include reflux, baseline high cricopharyngeal muscle contraction, unusually weak posterior cervical esophageal wall, etc. It could also be a combination of factors. However, upon further study, none of these ideas have explained why some people develop it and others do not. The formation of the pouch does not appear to be hereditary. In many patients who have a Zenker’s diverticulum, other problems of the esophagus are present, though not always.

What are the most common symptoms of Zenker’s diverticulum?

The most common symptom of Zenker’s diverticulum is difficulty swallowing food. Food may actually come back up out of the mouth several minutes to even hours after eating. Patients also often complain of choking, feeling mucus collecting in the throat, hoarseness, or bad breath. The symptoms can be quite embarrassing and debilitating.

How is Zenker’s diverticulum diagnosed?

In patients with symptoms suggestive of Zenker’s diverticulum a very simple and safe x-ray called a Barium Swallow is performed. Upper endoscopy can also be used to diagnose a Zenker's diverticulum, but for purposes of determining whether a patient is a surgical candidate, a barium swallow MUST be obtained.

How is Zenker’s diverticulum treated?

Surgery is required to effectively treat patients with Zenker’s diverticulum. We use a minimally invasive endoscopic treatment developed at Duke University known as Endoscopic Staple Diverticulostomy. Watch a slideshow or watch video. This treatment is safe, effective, and well tolerated. Dr. Chang has published articles in peer-reviewed journals and even wrote a book chapter describing this disorder and its treatments. There are other surgical methods which we do not generally advocate.

However, not all patients with Zenker's Diverticulum are candidates for ESD. If the pouch is too small (< 1.5 cm) than other approaches are better suited including CO2 laser, trans-cervical excision, or transoral excisional approach. We do not offer these other approaches in our office.

If you live far away, click here on instructions on how to get treated in our office.

What are the risks of surgery?

Risks with ESD along with risks involved with other surgical methods are reviewed here.

Are there any alternative treatments to surgery?

There are no other non-surgical treatments presently available to effectively treat patients with Zenker’s diverticulum. Surgery is the only treatment that will permanently relieve symptoms and improve the quality of life for patients. In patients who do not desire surgical treatment, alterations in diet may help to lessen the side effects of the pouch. No medications are available that will treat Zenker’s diverticulum.

What can happen if the Zenker’s diverticulum is not treated?

The main problem will be continued difficulty swallowing. The risks associated with having a Zenker’s diverticulum are weight loss and malnutrition, and pneumonia caused by food entering the lungs from the pouch. Although uncommon, these can be life-threatening.

What do I do if I think I have a Zenker’s diverticulum?

You should discuss your symptoms with your doctor who can then order a barium swallow x-ray. This test will confirm if a pouch is present. If you have a Zenker’s diverticulum, a consultation for surgery is the next step. As we do not maintain a list of surgeons around the country who perform this procedure, we are unable to assist those who live far away to find a local surgeon. However, we have assisted patients who live far away to have the surgery done by Dr. Chang in Northern Virginia.

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