Zenker's (pharyngoesophageal) diverticulum
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Epidemiology
- generally occurs in patients > 50 years of age (generally men)[5]
Pathology
- development of diverticulum in a natural area of weakness in the posterior hypopharyngeal wall between the cricopharyngeus & thyropharyngeus (inferior pharyngeal constrictor)[5]
Clinical manifestations
- dysphagia for solid & liquid foods
- may be especially prominent in the cervical region
- regurgitation of undigested food & pills (consumed on previous days)
- halitosis
- fullness of the neck during meals
- gurgling noise in the throat[5]
- no choking or a sensation that food is stuck
- pulmonary aspiration
- develops slowly
- duration of symptoms: from weeks to years (case of 5 years)[11]
Radiology
- barium swallow (image)[6]
- endoscopy (after barium swallow) to rule out malignancy & mucosal abnormalities prior to surgical correction -> often done fluoroscopically over a guide wire to minimize risk of perforation
Complications
- aspiration pneumonia
- significant weight loss
- esophageal compression -> esophageal obstruction
- fistula
Differential diagnosis
- dysphagia due to Parkinson's disease rarely regurgitate food
- dysphagia due to achalasia is intermittent
- dysphagia due to eosinophilic esophagitis associated with refractory heartburn
Management
- surgery (no consensus regarding best surgical approach)
More general terms
References
- ↑ UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - ↑ Al-Kadi AS, Maghrabi AA, Thomson D, Gillman LM, Dhalla S. Endoscopic treatment of Zenker diverticulum: results of a 7-year experience. J Am Coll Surg. 2010 Aug;211(2):239-43 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20670862
- ↑ Brace M, Taylor SM, Trites JR, Bethune D, Attia E, Hart RD. Endoscopic stapling versus external transcervical approach for the treatment of Zenker diverticulum. J Otolaryngol Head Neck Surg. 2010 Feb;39(1):102-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20122352
- ↑ Jump up to: 5.0 5.1 5.2 5.3 5.4 5.5 Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19. American College of Physicians, Philadelphia 2015, 2018, 2022
- ↑ Jump up to: 6.0 6.1 Le Mouel JP, Fumery M Zenker's Diverticulum. N Engl J Med 2017; 377:e31. Nov 30, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29171816 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMicm1701620
- ↑ Jump up to: 7.0 7.1 Yang J, Novak S, Ujiki M et al. An international study on the use of peroral endoscopic myotomy in the management of Zenker's diverticulum. Gastrointest Endosc 2019 May 10; PMID: https://www.ncbi.nlm.nih.gov/pubmed/31082393 https://www.giejournal.org/article/S0016-5107(19)31680-3/pdf
- ↑ Mayo clinic: Treatment of Zenker's diverticulum https://www.mayoclinic.org/medical-professionals/digestive-diseases/news/treatment-of-zenkers-diverticulum/mac-20431393
- ↑ Hannan SA, Alusi G Images in Clinical Medicine. Zenker's Diverticulum. N Engl J Med. 2006 Jun 8;354(23):e24. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16760438 https://www.nejm.org/doi/pdf/10.1056/NEJMicm050445
- ↑ Law R, Katzka DA, Baron TH. Zenker's Diverticulum. Clin Gastroenterol Hepatol. 2014 Nov;12(11):1773-82; PMID: https://www.ncbi.nlm.nih.gov/pubmed/24055983 Review.
- ↑ Jump up to: 11.0 11.1 NEJM Knowledge+
- ↑ Albers DV, Kondo A, Bernardo WM, et al. Endoscopic versus surgical approach in the treatment of Zenker's diverticulum: systematic review and meta-analysis. Endosc Int Open. 2016;4(6):E678-E686 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27556078 PMCID: PMC4993875 Free PMC article. Review https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0042-106203