Zenker's (Diverticulum) refers to an uncommon pouch or sac that forms in the upper throat, specifically at the back of the pharynx (throat) just above the esophagus's upper sphincter. This condition occurs when the cricopharyngeus muscle (the upper esophageal sphincter) doesn't relax properly during swallowing, causing pressure to build and push the delicate lining (mucosa) outward, creating a pocket that traps food and liquids. Symptoms include difficulty swallowing (dysphagia), regurgitating undigested food, bad breath (halitosis), and coughing, often worsening over time and affecting older adults.
The ENT specialist often uses a laser or may use a stapler to widen the opening to the bulge. Sometimes, the ENT specialist can remove the pouch with the laser device. This is called an endoscopic diverticulectomy. Electrocautery is another choice, but it's rarely used with the rigid endoscope procedure.
Zenker's diverticulum develops when the muscle between the throat and esophagus, known as the cricopharyngeus muscle, over-tightens, causing the throat above it to pouch out. Overtime, the pouch can enlarge as the muscles below it tighten excessively. Food can catch in this pouch or it can cause an obstruction.
The most common symptom of Zenker's diverticulum is difficulty swallowing. You might feel like you have a lump in your throat that makes it hard to swallow food or medication. Zenker's diverticulum can result in bad breath, persistent coughing, and a hoarse speaking voice.
The long-term symptoms recurrence rate ranges from zero to 47%. Mortality occurs in zero to 1% and morbidity, which includes recurrent laryngeal nerve damage, bleeding, mediastinitis, dental injury, esophageal perforation, diverticulum perforation, and cervical emphysema, occurs in 10% to 31%.
Risk factors for Zenker's diverticulum include:
1 Esophagectomy is an extensive procedure that carries a high risk (40–60%) of serious and sometimes lethal complications. 1 The long-term (5-year) survival after surgery is limited—only 31% according to nationwide population-based studies from Sweden.
Endoscopic staple-assisted oesophagodiverticulostomy has gained widespread acceptance and is often considered the first-line choice for treatment of ZD. The technique has become the most frequent surgical intervention for pharyngeal pouch performed in ENT practice in UK 38.
The occurrence of squamous cell carcinoma (SCC) arising in Zenker's diverticulum is a very rare entity. However, the published incidence rates fall between 0.3% and 7% among occasional reports in the literature [3].
Red flags. Any dysphagia is of concern, but certain findings are more urgent: Symptoms of complete obstruction (eg, drooling, inability to swallow anything) New focal neurologic deficit, particularly any objective weakness.
Once the diverticular sac becomes large enough to retain contents such as undigested food, mucus or sputum, patients may complain of: Food regurgitation (swallowed food brought back up into the mouth) Halitosis (foul-smelling breath)
We suggest that acid reflux induces longitudinal esophageal shortening, which in turn increases the risk for the development of herniation between 2 spatially related structures, the pharyngeal constrictors and cricopharyngeus muscles, leading to the development of Zenker diverticulum.
The surgery to repair this pouch is either done on the inside through your mouth (endoscopic) or through an incision in your neck (open). Most patients prefer the endoscopic approach because the procedure and the recovery is usually shorter. A majority of patients can have the endoscopic repair.
No specific food heals esophagitis. However, plenty of options can help minimize irritation as your esophagus recovers. If your esophagus is very inflamed and painful, Cleveland Clinic says to lean on softer, nutrient-dense foods, such as: Avocado.
Swallowing exercises can increase strength, mobility, and control of these muscles. Over time, this may help you to swallow normally again. A speech-language pathologist (SLP) may prescribe certain swallowing exercises to improve your swallowing. The specific exercises will depend on your swallowing problem.
With a minor Zenker's diverticulum, a person may develop bad breath or a gurgling in the throat. When the pouch is large, more severe symptoms can occur, such as a mass in the neck, regurgitation of food into the mouth and, lastly, potential aspiration of food into the lungs, which can lead to pneumonia.
What Are the Treatment Options? If you have any of the symptoms mentioned here, you should be examined by an ENT (ear, nose, and throat) specialist, or otolaryngologist. Your ENT specialist may diagnose your condition using a “barium swallow” study.
A pharyngeal pouch is like a hernia at the top of your oesophagus. They usually grow slowly and it can be many years before patients realise they have problems. While some pouches do not cause any problems, some can cause difficulty swallowing, regurgitation of food and lead to chest infections.
Zenker's Diverticulum
PAIN • You may have a mild sore throat, and can extra strength Tylenol or a mild narcotic as needed. Mild pain with swallowing or difficulty swallowing may occur, and should improve within a week. Abstain from heavy lifting (more than 10 lbs) or strenuous activity and exercise for one week.
Zenker's diverticulum is a pouch that forms in your throat. It develops when food can't move from your throat to your esophagus. The pouch may not cause problems unless it gets big enough to keep you from swallowing food. It doesn't go away on its own.
Zenker's diverticulum, also known as the esophageal diverticulum, is a herniation of the mucous and submucosal layers through the muscular layer at a level below the thyropharyngeal muscle and above the cricopharyngeal muscle.
After an esophagectomy, your care team will move you to the intensive care unit (ICU) for a day or two. You'll start receiving nutrition through the feeding tube, and your care team will adjust the epidural to manage pain. You may be in the hospital for up to two weeks after surgery.
The most commonly reported causes of death and complications after transthoracic esophagectomy have been pulmonary complications and anastomotic leakage. Major pulmonary complications occurred in 19% of patients in this series and accounted for 45.5% of the deaths.
Most people report improved quality of life after esophagectomy, but some symptoms usually continue. Your doctor will likely recommend comprehensive follow-up care to prevent complications after surgery and to help you adjust your lifestyle.