Zenker's Diverticulum Endoscopic Treatment Confusion

Having treated many patients with Zenker's Diverticulum using the endoscopic approach, I've had many confused patients ask me how the diverticulum is treated if it is not removed.

For those unfamiliar with this disorder, click here for more information.

The basic concept of treating this rare disorder is that there is a common wall that divides the esophagus from the diverticulum pouch. This common wall is endoscopically divided such that the pouch now becomes the new back wall of the esophagus. So when the patient swallows, food/liquids can no longer get "trapped" causing symptoms.

Still confused? Here are some picture illustrations...

When endoscopically exposed, the pouch is denoted by the arrow.

When looking through the scope placed into the mouth down into the throat, there is a common wall that is between the pouch (blue arrow) and esophagus (green arrow).

Endoscopically, whether using a stapler or laser, this wall is divided down the middle. This picture shown below is when a stapler is used.

Here is the side view before and after common wall division:

After the procedure, any food/liquid substances that are swallowed can't be trapped in the pouch. Therefore, even though nothing is surgically removed, the patient's swallowing symptoms completely disappear.

Hopefully, this explanation helps clear up any confusion of what exactly happens!

Bilateral Lateral Hypopharyngocele (Cervical Esophageal Diverticulum)

I recently was asked to review this interesting (and rare) disorder in which a diverticulum or pouch has formed on both sides of a patient's upper esophagus. This condition which I'll call bilateral lateral "hypopharyngocele" is even more rare than Zenker's Diverticulum which is also not very common.

Check out the barium swallow which shows a barbell like image. The "barbell" part is the abnormal pouch and is found on both sides.

A paper was actually written about this condition by Dr. Chang.

Reference:
Bilateral Pharyngoceles (versus Branchial Cleft Anomalies?) and Endoscopic Surgical Considerations. Annals of Otology, Rhinology, & Laryngology. 114(7):529-532, 2005.

New Surgical Approach to Treat Small Zenker's Diverticulum

In the January 2010 edition of Laryngoscope, an interesting paper entitled "Transoral resection of short segment Zenker's diverticulum and cricopharyngeal myotomy: an alternative minimally invasive approach" was published on a new endoscopic approach to surgically treat very small Zenker's Diverticulum. This endoscopic approach is also able to treat cricopharyngeal spasms/hypertrophy.

Just as for the Endoscopic Staple Diverticulostomy (ESD), the most common endoscopic approach to treat Zenker's diverticulum, a Weerda laryngoscope is used to visualize the pouch. However, instead of using a stapler to treat the pouch, the pouch is everted into the esophagus and the pouch excised. The cricopharyngeal muscle is than incised under the microscope as well as endoscopically before the mucosal incision is closed using sutures.

The authors have called this procedure Trans-Oral Resection of Diverticula (TORD). When used to treat the cricopharyngeal muscle only, the procedure is called Trans-Oral Cricopharyngeal Myotomy (TOCPM).

Patients generally go home after 24 hours.

Read more about this research here.

No... our office does not offer these procedures at this time. Only the ESD approach.