The typical patient with Zenker’s Diverticulum is elderly, frail and often debilitated from chronic aspiration. Symptoms of the diverticulum can include dysphagia, regurgitation of food particles or pills after swallowing, “wet” sounding voice, chronic cough and pneumonia. Not uncommonly, these are incidentally found at time of EGD, barium swallow or esophagram performed for some other reason.
Zenker’s Diverticulum is a pouch that forms in the upper esophagus. The mechanism is that of failure of the upper esophageal sphincter to relax. Over time, repetitive swallowing efforts produce pressure on the esophageal wall. This pressure causes the esophageal wall to balloon out, sometimes several centimeters in diameter. When a pouch develops, food and pill debris can be trapped in the diverticulum, rather than passing into the lower esophagus and stomach.
The condition is most commonly found in patients over 60 years old. The preferred method for diagnosis is a combination of flexible endoscopy and X-ray with swallowed contrast.
Because there is no medicine to treat the condition, Zenker’s Diverticulum is corrected by surgery. Conventionally this has been done through a lower neck incision, dividing the cricopharyngeal muscle and removing the diverticular sac.
The endoscopic approach is a minimally invasive surgical procedure. Age in of itself is not a contraindication to this type of minimally invasive surgery. While the patient is under general anesthesia, the surgeon inserts a rigid telescope into the mouth, throat, then esophagus. With the aid of a microscope and laser, a small incision is made to divide the muscular ring in the upper esophagus, micro-cricopharyngeal myotomy. This sphincterotomy relieves the constriction of the muscle around the esophagus and allows ready passage of food or pills without removal of any tissue.
The procedure routinely takes thirty minutes and is generally performed on an outpatient basis. Patients commonly experience immediate and significant improvement when swallowing after the surgery.
Zenker’s Diverticulum is usually resolved with one surgery, and no tubes or drains are needed. Complications and problems are very rare, but a liquid diet is necessary for a short period of time after the surgery. When compared with neck incision, the benefits are numerous:
Consistent relief of symptoms
No incision to the skin
No risk to nerves of the voice box
Usually an outpatient procedure
Quicker return to eating and drinking
Quicker return to normal activities
Wayne Colin, DMD, MD, Lexington Clinic Otolaryngologist, has almost 15 years experience using this minimally invasive approach. Dr. Colin is dedicated to providing his patients with compassionate care and state-of-the-art treatments. Please visit http://www.osasurgery.com for information relating to state-of-the-art surgery for Obstructive Sleep Apnea.
For more information or to schedule an appointment, please call the Lexington Clinic Otolaryngology/ENT Department at 859.258.4371.