Our bodies keep it contracted to stop food from coming back up into our throats. Chang has treated patients with zenker s diverticulum, a rare throat pouch, from throughout the united states using only the minimally invasive, rigid endoscopic technique known as endoscopic staple diverticulostomy or esd. There are two common surgeries performed for treatment of zenker s diverticulum. Sometimes, other conditions are present alongside zenker s. Individuals with the condition are urged to seek treatment even if the pouches are still small. As the diverticlulum enlarges it produces progressive dysphagia, regurgitation, and aspiration. Meditation on the pathogenesis of hypopharyngeal zenker s diverticulum and a report of endoscopic treatment in 545 patients. Dysphagia after endoscopic repair of zenkers diverticulum. Zenker diverticulum zd is an uncommon pharyngoesophageal outpouching that occurs in an area of muscular weakness at the junction of the inferior aspect of the inferior constrictor muscle. A zenker s diverticulectomy three procedures have been described to treat a zenker s diverticulum. The etiology of zenker s diverticulum has been a topic of much debate, but increased intraluminal pressure from cp muscle dysfunction is most often implicated. Discusses future directions in dysphagia treatment.
Zenkers diverticulum an overview sciencedirect topics. A barium swallow is a special xray that highlights the inside of your mouth, pharynx, and esophagus. Zenkers or cricopharyngeal diverticula are pulsion diverticula which form as a result. In that area, there is a weak spot, called killians triangle, and when the pressure from the swallowed food in the pharynx is high, the weak spot can herniate creating a sack. Zenkers diverticulum free download as powerpoint presentation. The outpouching is associated with halitosis, dysphagia. The remainder of patients had resolution of dysphagia and normalized mbs. The condition goes by several names, depending on the location of the pouch.
Zenker s diverticulum zd may be treated with a variety of endoscopic or open surgical techniques. A novel device for exposing, stretching and fixing the septum, and optimizing the operative. Management of zenkers diverticulum has dramatically progressed during past decades. Zenkers diverticulum and swallowing disorders treatment. Treatment of zenker s diverticulum through a flexible endoscope with a transparent obliqueend hood attached to the tip and a monopolar forceps. The surgery is designed to release the tightened cricopharyngeal muscle, often in conjunction with removal of the zenker s diverticulum sac. The natural history of this condition is progressive enlargement of the diverticulum with increasing symptomatology. Treatment for zenkers diverticulum is aimed in alleviating the presenting symptoms of the client. No medications are available that will treat zenker s diverticulum and surgery is the only treatment that will permanently relieve symptoms. However, when surgery is not possible in many symptomatic older patients who are poor surgical candidates may attempt other minimally invasive procedure with endoscopy.
A condition that progressively worsens over time, esophageal diverticulum most often strikes adults over 60 years of age. Due to the distress experienced by patients from symptoms of the diverticulum, as well as the risk of aspiration and pneumonia, surgical intervention is recommended for all patients with zenker s diverticulum that are physically able to undergo surgery. Endoscopic diagnosis and management of zenkers diverticula. Changes in swallowingrelated quality of life after. This book is distributed under the terms of the creative commons. Pharyngeal pouch zenkers diverticulum postgraduate.
The objective of an excision of zenker s diverticulum is not only to remove the diverticulum, but to release the malfunctioning muscle of the throat the cricopharyngeus cp muscle. Isnt dysphagia in the patient with a zenkers diverticulum related to. Gastroenterologists in florida zenkers diverticulum. Zenker s diverticulum is a pseudodiverticulum of the esophagus that forms in the killians triangle, between the inferior pharyngeal constrictor and the cricopharyngeus cp muscle. They will have more trouble with solid than with liquid foods because the solid food will get caught in the pouch. Zenkers diverticulum tough to swallow cornerstone ear. Endoscopic stapling technique for the treatment of zenker. The most common form, zenkers diverticulum is found at the level. The aetiology remains unknown but theories centre upon a structural or physiological abnormality of the cricopharyngeus. Aspiration pneumonitis may result if regurgitation is nocturnal. Zenkers diverticulumminimally invasive treatment by. A new treatment for zenker s diverticulum submucosal tunneling endoscopic septum division stesd the safety and scientific validity of this study is the responsibility of the study sponsor and investigators.
There is no medical treatment for patients with zenkers diverticulum. Surgical treatment has evolved, formerly requiring an external incision and resection of the diverticulum but more recently being accomplished using. Surgical intervention is the only treatment available that will effectively cure patients with a zenkers diverticulum, permanently relieving symptoms and improving the quality of life. Zenkers diverticulum and cp dysfunction fact and fiction joshua s. The aim of this prospective study was to evaluate swallowing dysfunction in patients diagnosed with zenker s diverticulum using the swallowing quality of life swalqol questionnaire preoperatively. Minimally invasive treatment of zenker diverticula. Rarely, the pouch becomes large, causing dysphagia and sometimes a palpable neck mass. Treatment of zenker s diverticulum once the zenkers diverticulum is identified and it is determined that it is the cause of the swallowing difficulty, then treatment options can be considered. Zenkers diverticulum location, symptoms, treatment. This can lead to serious illnesses, such as pneumonia, or even death.
A new treatment for zenkers diverticulumsubmucosal. Dysphagia evaluation and management in otolaryngology. When we swallow, the cp relaxes to let the food pass. Zenkers diverticulum zd is a saclike outpouching of the mucosa and submucosa. It involves an openneck operation where thezenkers hernia. Zenkers diverticulum is a type of diverticulum that develops in the. A common reason for dysphagia, particularly in older adults, is a zenker s diverticulum pharyngeal pouches. Esophageal diverticula msd manual professional edition. The more common etiologies of dysphagia that lend themselves to surgical correction are described. Management of zenker and hypopharyngeal diverticula richard. Surgery is the standard of treatment but, for older or infirmed patients, life style and dietary modifications can be considered. On xray, the diverticulum appears as a round balloon that fills with radiopaque material as the patient swallows. Zenker diverticulum an overview sciencedirect topics. Zenkers diverticulum is an outpouching of an area where the pharynx is connected to the esophagus.
They are more common in older patients who present with dysphagia but may have aspiration and pulmonary compromise. A zenkers diverticulum is a small pouch that develops in the upper part of the esophagus and causes dysphagia difficulty in swallowing. A zenkers diverticulum is a pouch that forms in the throat at the very beginning of the digestive tract just above the upper esophageal sphincter ues. A contrast material called barium is swallowed and the diverticulum is able to be visualized using a realtime xray called fluoroscopy. Zenkers diverticulum zd is a rare acquired outpouching of esophageal mucosa that typically occurs during the 7th or 8th decade of life. Individuals that have a zenkers diverticulum will have trouble swallowing foods. Zenker s diverticulum zd is a saclike outpouching of the mucosa and submucosa through killians triangle, an area of muscular weakness between the transverse fibers of the cricopharyngeus muscle and the oblique fibers of the lower inferior constrictor ie, thyropharyngeus muscle. A diverticulum is a side pocket that forms when pharyngeal or esophageal muscle herniates. Typical symptoms are regurgitation, dysphagia, halitosis and chronic cough. Zenker s diverticulum is diagnosed using a test called a barium swallow. Dysphagia cervical osteophytes dish esophageal diverticula. Disruption of the ability to swallow, known as dysphagia, can compromise nutrition. It has been known that the best option for this condition is to do nothing. Brandt, in brocklehursts textbook of geriatric medicine and gerontology seventh edition, 2010.
Zenkers diverticulum southern california, orange county. Diverticulectomy is usually selected for treating large diverticula in otherwise healthy patients 1. Is a swelling or pulsion that forms at the back of the throat at the junction of the pharynx and esophagus in older. A zenker diverticulum fills with food that might be regurgitated when the patient bends or lies down. The most common treatments are open surgical diverticulectomy with cricopharyngeal myotomy or diverticulopexy. Dysphagia affects the most cardinal of human functions. Patients with a zenkers diverticulum are also at increased risk for aspirating or inhaling food or saliva into the lungs. As the pouch enlarges and dysphagia increases, symptoms become more. A barium swallow fluoroscopy allows your doctor to see how you swallow in motion. Since 90% of patients with a zenker diverticulum have a hiatal hernia and gastroesophageal reflux, the distal esophagus should also be evaluated. Zenker s diverticulum is a pouch at the back of the throat at a weak spot where the throat and esophagus join. Zenkers diverticulectomy postopafter care mount sinai. This presentation was done at the mm meeting to discuss techniques and management of a zenker s diverticulum. To evaluate dysphagia characteristics in patients with zenkers diverticulum zd.
Zenkers diverticulum ent services in arizona valley ent. Chhetri md, in dysphagia evaluation and management in. These diverticula are uncommon and tend to occur in elderly people. Sometimes a pouch, called a zenkers diverticulum, can form just above the muscle. A diverticulum is an abnormal outpouching or pocket forming off the wall of the gastrointestinal wall. Zenker s diverticulum is a benign, rare condition that can affect your quality of life significantly because it. Most instances of esophageal perforation are iatrogenic. Flexible endoscopic zenkers diverticulotomy with a novel bipolar forceps. Cricopharyngeal myotomy remains a key element of surgical treatment of zenker diverticulum zd. Treatment for zenker s diverticulum is based on the severity of symptoms. Pharyngeal pouches occur most commonly in elderly patients over 70 years and typical symptoms include dysphagia, regurgitation, chronic cough, aspiration, and weight loss. Textbook of surgery th edition 1986 sabiston dc jr, ed. Zenkers diverticulum is a rare disease, which can cause considerable suffering.
A diagnosis is easily established on barium studies. Zenkers diverticulum uci head and neck surgery uci. Zenkers diverticulum zd, also known as cricopharyngeal. This relatively uncommon disorder, which occurs more commonly in the elderly, presents with symptoms of dysphagia. He has written numerous publications as well as a book. Zenkers diverticulum zd results from posterior herniation of esophageal mucosa into killians triangle, an area of least resistance situated above the cricopharyngeus cp muscle and below the inferior pharyngeal constrictor muscle. Predominant symptoms are dysphagia and regurgitation. Management of zenker and hypopharyngeal diverticula. Background presently, the 2 most widely used methods for the treatment of zenker diverticulum are endoscopic stapling of the common party wall between the diverticulum sac and the esophagus and the standard openneck technique involving diverticulectomy and cricopharyngeal myotomy. Dysphagia that is the result of persistent cricopharyngeal spasm andor a zenker s diverticulum is particularly amenable to surgical correction. Zenker s diverticulum is the most common type of diverticulum in the esophagus. Treatment the treatment for a zenkers diverticulum is cutting the cricopharyngeus muscle, known as a cricopharyngeal myotomy.
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