Evaluation of Esophageal Diverticula

Abstract

Esophageal diverticula are outpouchings that protrude from the esophageal wall. They commonly are classified according to their anatomic location in the esophagus: Zenker’s diverticulum (ZD) in the upper esophagus, mid-thoracic or mediastinal diverticula in the mid-esophagus, and epiphrenic (ED) in the distal esophagus. Histologically, there are two types of esophageal diverticula: true diverticulum which consists of all layers of the esophagus and false diverticulum which includes only two layers, mucosa and submucosa. Etiologically, esophageal diverticula could be congenital, very rare, or acquired which is most common. Most esophageal diverticula are asymptomatic. However, when large, they are associated with symptoms including dysphagia, regurgitation, chest pain, and aspiration-related complications. A thorough evaluation involves a combination of contrast esophagogram and upper endoscopy to assess esophageal anatomy as well as an esophageal manometry to evaluate the functional status of the esophagus. Treatment is not required for most diverticula as they are asymptomatic. Large or symptomatic diverticula should be treated. Treatment is tailored to the pathophysiology and location of the diverticulum. Surgical options include diverticulectomy or diverticular suspension (in case of ZD) with a myotomy. Fundoplication, usually partial, is added in cases of epiphrenic diverticulum. Minimally invasive transoral endoscopic stapled diverticulectomy approach is increasing in popularity and has been performed in cases of ZD, especially in high-risk surgical patients.