Treatment of Zenker's diverticulum

Abstract

Although Ludlow1 in 1769 gave the first description of a pharyngo-esophageal diverticulum, it is named after Zenker who gave a precise pathologic description more than one century later2. Zenker’s diverticulum (ZD) is the commonest type of diverticulum in the upper gastro-esophageal tract. It is a herniation which usually arises in the posterior midline of the hypopharynx at a place where the muscular wall has weakened. The ZD is usually located just cranial to the upper esophageal sphincter (UES) of which the cricopharyngeal muscle is a part. However, a ZD can develop at any weak site of the muscular wall of the hypopharynx. Increased hypopharyngeal pressures during swallowing are probably important in the pathogenesis of the diverticulum3 4. The tissue bridge between the esophageal lumen and the pouch of the diverticulum is composed of mucosa, submucosa and fibrous tissue of varying thickness, and a muscular coat. In this tissue bridge the most voluminous and essential structure is the UES.