Zenker’s Diverticulum

Zenker’s diverticulum is a condition where a pouch develops in the back of the throat where the throat connects to the esophagus. The pouch grows as the muscles overtighten and make swallowing difficult. Food and saliva can become trapped with the outpouching of the esophagus.

The most common symptom of Zenker’s diverticulum is dysphagia (difficulty swallowing) to both solids and liquids. Other symptoms include:

• Coughing or choking when eating
• Difficulty swallowing
• Excessive phlegm in throat
• Feeling of a lump in your throat
• Halitosis (bad breath from food stuck in the pouch)
• Regurgitation of food (often hours after eating)

Zenker’s diverticulum is often associated with other conditions such as hernias, Gastroesophageal reflux disease (GERD), or esophageal spasms.

An esophagram (or barium swallow) test can confirm the diagnosis of Zenker’s diverticulum. In this test, barium contrast is swallowed and pictures are taken as you swallow to determine what is causing the difficulty swallowing and if a Zenker’s diverticulum is present. Treatment for Zenker’s diverticulum can depend on the size of the pouch and the severity of related symptoms. In mild cases, a change in diet to softer, easy to swallow foods may reduce symptoms. In more complex cases, the suggested treatment is an endoscopic therapy called Z-POEM. 

In more complex cases of Zenker's diverticulum, endoscopic treatment is suggested to relieve the blockage to fold passage caused by the Zenker’s diverticulum to restore swallowing function. A flexible endoscope can be used to perform a therapy called Z-POEM (short for peroral endoscopic myotomy for Zenker’s). This procedure relaxes the tight muscle associated with the Zenker’s diverticulum that blocks food passage into the esophagus, so food can pass through easily again. The scope is passed through the mouth to reach the Zenker’s diverticulum. Patients may stay overnight for observation and typically start liquids by mouth the day after the procedure.