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