Zenker’s Diverticulum

What is Zenker’s diverticulum?
Zenker’s diverticulum is a pouch that forms at the top of the esophagus (the tube that carries food from the mouth to the stomach). It’s uncommon — roughly 0.01–0.1% of people in the U.S. are affected — and is most often diagnosed in men between about 60 and 80 years of age. When the pouch fills with food, liquid or saliva it can interfere with swallowing and cause other bothersome symptoms.

What causes it?
The exact cause isn’t fully known, but most experts agree the problem relates to dysfunction of the cricopharyngeal muscle (the upper esophageal sphincter). If that muscle fails to relax or is weak, pressure during swallowing can push the lining of the esophagus outward through a weak point, creating the pouch (a “pulsion” diverticulum). Zenker’s is more commonly seen in older adults and is sometimes associated with gastroesophageal reflux disease (GERD) or hiatal hernia.

Symptoms to watch for
Small pouches (typically under about 2 cm) may produce no symptoms. As a pouch enlarges, it can collect food, drink, mucus and pills and produce symptoms such as:

• Dysphagia (difficulty swallowing) — the most common symptom.
• Regurgitation of undigested food or liquid, sometimes hours after eating.
• Bad breath (halitosis) caused by trapped food.
• A persistent sensation of food “stuck” in the throat.
• Coughing, choking, or aspiration (breathing food or liquid into the lungs), which can lead to pneumonia.
• Unexplained weight loss, hoarseness, or frequent belching.

If you experience sudden severe symptoms — such as choking, fever, or coughing with breathlessness — consult with your Berger Henry otolaryngologist.

How it’s diagnosed
An ear, nose and throat specialist (ENT) usually evaluates patients suspected of having Zenker’s.

• Common diagnostic steps include:
  Barium swallow (esophagram): you drink a contrast solution while X-rays are taken; the pouch fills with contrast and shows up clearly on imaging — this test defines the size and location of the diverticulum.
• Upper endoscopy (esophagogastroduodenoscopy): a flexible camera examines the throat and esophagus directly, can detect trapped food, and helps rule out other conditions. Endoscopy is often used if surgery is being considered.

When to treat and what options exist
If the pouch is small and not causing symptoms, no treatment may be needed — periodic monitoring is reasonable. For symptomatic patients, the goal of treatment is to relieve obstruction by addressing the dysfunctional cricopharyngeal segment and eliminating the pouch’s tendency to trap material.

Treatment options include:

Minimally invasive endoscopic procedures (through the mouth)

• Endoscopic septotomy (or endoscopic stapling/division): the shared wall (septum) between the pouch and the esophagus is cut or divided so the pouch becomes part of the esophageal lumen and no longer traps food. These procedures are typically shorter, avoid a neck incision and have faster recovery times. Recent techniques use staplers, lasers or electrocautery to divide the septum.

Open neck surgery

• External (open) approaches may involve removing the pouch (diverticulectomy) or suspending it (diverticulopexy), usually combined with cricopharyngeal myotomy (cutting the tight muscle). Open surgery is recommended in some anatomic situations or when endoscopic access is limited or contraindicated.

Choosing an approach and recurrence
Each option has pros and cons. Endoscopic approaches are less invasive with quicker recovery but some series report higher recurrence rates over long-term follow-up. Open procedures are more invasive but may have lower recurrence for selected patients. Published recurrence figures vary widely depending on the technique, surgeon experience and length of follow-up — some reports cite recurrence rates ranging from the low double digits up to nearly half of patients in older series. Newer endoscopic techniques and improved patient selection have reduced recurrence in many centers. Your surgeon will review the risks, benefits and expected outcomes for your specific case.

Recovery and follow-up
Most patients experience prompt improvement in swallowing and reduced regurgitation after successful treatment. Follow-up typically includes clinical visits and, when indicated, imaging or endoscopy to confirm the pouch has been adequately treated. Because recurrence is possible, especially with some techniques, clinicians counsel patients to report returning symptoms promptly.

When to seek urgent care
Seek immediate care for severe pain, fever, signs of infection, sudden worsening of swallowing, or respiratory symptoms suggesting aspiration. These can be complications requiring urgent attention.

Bottom line
Zenker’s diverticulum is a treatable cause of chronic throat symptoms in older adults. Diagnosis is usually straightforward with a barium swallow and endoscopy, and effective treatments exist ranging from minimally invasive endoscopic procedures to open surgery. Because treatment choice and outcomes depend on pouch size, anatomy and overall health, decisions should be individualized and made in consultation with an experienced ENT or upper-GI surgeon.

Zenker’s diverticulum can cause significant esophageal discomfort and interfere with swallowing and your daily life. At Berger Henry ENT, our team is dedicated to providing comprehensive care to address and manage the symptoms of Zenker’s.

If you’re experiencing symptoms of Zenker’s diverticulum — don’t wait. Contact us today to schedule your appointment, and let us help you find relief.