Topic > Zenker's diverticulum - 1380

Esophageal diverticula, or eversions, are not a very common event; it mainly affects the male population who have passed the seventh decade of life (Khan, Ismail and Van de Werke, 2012). There are two main types of diverticula: traction diverticula and pulsion diverticula. Traction diverticula, also commonly known as true diverticulum, herniate through all layers of the esophageal wall and are usually located in front of the tracheal bifurcation. They are mostly the result of congenital disorders that cause scarring in the esophagus and some diseases such as tuberculosis. These types of diverticula are not as common as drive-type diverticula (Bagheri et al., 2013). The impulse, also called false diverticulum or pseudodiverticulum, exclusively involves the mucous or submucosal layers of the esophagus, penetrating through the muscular layer. These diverticula are almost always acquired; very rarely they are considered a congenital anomaly (Bagheri et al., 2013). Zenker's diverticula, also known as cricopharyngeal or pharyngoesophageal, belong to the family of drive-type diverticula and were first described as early as 1769 (Baron, 2014). . It is the most common of all diverticula with a prevalence of 0.01-0.1% of the population and is observed much more frequently in men than in women (Sincleair, 2013). Zenker's diverticulum ends up becoming the primary diagnosis for 2% of all patients undergoing a fluoroscopic study for nonspecific dysphagia (Sincleair, 2013). This type of outflow forms in Killian's Triangle; a section between the inferior pharyngeal constrictor muscle and the cricopharyngeal muscle that was found to be rather weak compared to the rest of the pharynx and upper esophagus. Because of their location, endoscopic Zenker diverticulotomy did not gain popularity until the second half of the 20th century (Ferguson, 2011, p. 297). During this procedure, a diverticuloscope is inserted orally until it reaches the exit site. From this point, different surgeons will use different methods for treatment. Most commonly, a linear cutting endoscopic stapler is used, as in diverticular stapling. The muscular wall that divides the esophagus and the diverticula is destroyed, causing the diverticula proper to become the new posterior wall of the esophagus (Ferguson, 2011, p. 296). There are a few other methods for dividing the aforementioned wall between the esophagus and the diverticula themselves, but they are not as common as the stapler. These include the use of the carbon dioxide laser for cauterization, the endoscopic harmonic scalpel, the needle knife papillotome, and an argon plasma coagulator.