Swallowing Problems

Zenker's Diverticulum

Zenker's diverticulum illustration

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Zenker's diverticulum is a pouch that develops in the walls of the lower throat. It usually occurs in people over age 50. With every swallow, some food ends up in the pouch until the pouch fills. Once filled, the pouch presses on the upper esophagus, making it difficult for solid foods to pass. The filled pouch also spills food into the throat, causing coughing and spitting up of food swallowed many hours before; this especially happens when lying down at night. The pouch also causes problems for patients taking medications, because pills can get stuck in the pouch and are not absorbed through the stomach. The cause of Zenker's diverticulum is unknown, but it is thought to be due to a weak spot in the lower throat muscles.

The condition is evaluated and treated by specialists in Otorhinolaryngology and Speech-Language Pathology. When symptoms become significant, surgery is usually recommended. There are two approaches, conventional open surgery and an endoscopic approach. The open approach involves making an incision through the neck, locating the pouch behind the lower throat, cutting the cricopharyngus muscle that forms the top of the pouch and cutting out the pouch or tacking it upside down so that it cannot fill. The open approach requires a day or two in the hospital and has a very low rate of complications (infection, leaking or bleeding).

The endoscopic approach is done through the mouth using rigid metal tubes. A laser or stapling device is used to divide the cricopharyngus muscle and the wall between the pouch and the esophagus. This approach eliminates the pouch by making it part of the upper esophagus. Compared to open surgery, the endoscopic approach is faster, equally effective at relieving symptoms and has a lower complication rate. It is done as an outpatient or 23-hour stay.