Zenker's Diverticulum

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Esophageal diverticula, or outpouchings, are not a very common occurrence; predominantly affecting the male population that is past their seventh decade of life (Khan, Ismail, & Van de Werke, 2012). There are two main types of diverticulum: the traction and the pulsion-type. The traction, also commonly known as the true diverticulum, herniate through all layers of the esophageal wall and are usually found opposite of the tracheal bifurcation. They are mostly the result of congenital disorders that cause scarring of the esophagus and certain diseases such as tuberculosis. These types of diverticulum are not as common as the pulsion-type (Bagheri et al., 2013). The pulsion, known also as the false diverticulum or pseudodiverticulum, involve only the mucosal or submucosal layers of the esophagus penetrating through the muscular layer. These diverticulum are almost always acquired; very rarely are they seen as a congenital abnormality (Bagheri et al., 2013). Zenker’s diverticulum, also known as cricopharyngeal or pharyngoesophageal, belong in the family of pulsion-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 are seen much more frequently in men rather than women (Sincleair, 2013). Zenker’s diverticulum end up becoming the main diagnosis for 2% of all patients referred to a fluoroscopic study for nonspecific dysphagia (Sincleair, 2013). This type of outpouching forms in the Killian’s Triangle; a section between the inferior pharyngeal constrictor muscle and the cricopharyngeal muscle that has been proven to be rather weak compared to the rest of the pharynx and upper esophagus. Because of their location, Zenker’s ... ... middle of paper ... ...ndoscopic diverticulotomy did not gain popularity until the later half of the 20th century (Ferguson, 2011, p. 297). During this procedure, a diverticuloscope is inserted orally until it reaches the site of the outpouching. From this point, different surgeons will utilize different methods for treatment. Most commonly, an endoscopic linear cutting stapler is used, as in diverticular stapling. The muscular wall that divides the esophagus and diverticula is destroyed, causing the actual diverticula to become the new posterior wall of the esophagus (Ferguson, 2011, p. 296). A few other methods for dividing the aforementioned wall between the esophagus and the diverticula itself exist, but are not as common as the stapler. These include the use of carbon dioxide laser for cautery, the endoscopic harmonic scalpel, needle knife papillotome, and an argon plasma coagulator.

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