Zenker Diverticulum Surgery Workup

  • Author: Todd A Nickloes, DO, FACOS; Chief Editor: John Geibel, MD, DSc, MA   more...
 
Updated: Jan 6, 2012
 

Laboratory Studies

No specific laboratory studies are indicated for Zenker diverticulum, aside from otherwise medically indicated preoperative evaluations.

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Imaging Studies

Barium swallow is the diagnostic procedure of choice. Patients with symptomatic disease usually have a posterior midline pouch greater than 2 cm in diameter arising just above the cricopharyngeus muscle. No other study is required if no other abnormality is present.[9, 8] See the image below.

Illustrated barium swallow demonstrates the pouch Illustrated barium swallow demonstrates the pouch retaining contrast and its connection to the esophagus immediately inferior and posterior to the larynx.
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Other Tests

The history strongly suggests the diagnosis of Zenker diverticulum. Most patients (98%) present with some degree of dysphagia. When combined with regurgitation of undigested food particles, the differential diagnosis is mainly limited to Zenker diverticulum and achalasia.

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Diagnostic Procedures

Endoscopy is indicated if the contrast study shows esophageal mucosal irregularities for which neoplasia must be excluded.[17]

Esophageal manometry is indicated if achalasia or another esophageal motility disorder is suspected from the contrast study.

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Contributor Information and Disclosures
Author

Todd A Nickloes, DO, FACOS  Assistant Professor, Department of Surgery, Division of Trauma/Critical Care, University of Tennessee Medical Center-Knoxville

Todd A Nickloes, DO, FACOS is a member of the following medical societies: American College of Osteopathic Surgeons, American Medical Association, American Osteopathic Association, Association for Academic Surgery, Eastern Association for the Surgery of Trauma, Society of Critical Care Medicine, Society of Laparoendoscopic Surgeons, Southeastern Surgical Congress, and Southern Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

LaMar O Mack, MD  Resident Physician, Department of Surgery, University of Tennessee Medical Center

LaMar O Mack, MD is a member of the following medical societies: American Urological Association, National Medical Association, and Student National Medical Association

Disclosure: Nothing to disclose.

Brian Reed, MD  Staff Physician, Department of Surgery, University of Tennessee Medical Center

Brian Reed, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Alex Jacocks, MD  Program Director, Professor, Department of Surgery, University of Oklahoma School of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Amy L Friedman, MD  Professor of Surgery, Director of Transplantation, State University of New York Upstate Medical University College of Medicine, Syracuse

Amy L Friedman, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Medical Women's Association, American Society for Artificial Internal Organs, American Society of Transplant Surgeons, American Society of Transplantation, Association for Academic Surgery, Association of Women Surgeons, International College of Surgeons, International Liver Transplantation Society, New York Academy of Sciences, Pennsylvania Medical Society, Philadelphia County Medical Society, Society of Critical Care Medicine, and Transplantation Society

Disclosure: Nothing to disclose.

Paolo Zamboni, MD  Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy

Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA  Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, Surgical Research, Department of Surgery, Yale-New Haven Hospital

John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract

Disclosure: AMGEN Royalty Consulting; ARdelyx Ownership interest Board membership

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Michael J Sutherland, MD, and Brian D Peyton, MD, to the development and writing of this article.

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Illustrated barium swallow demonstrates the pouch retaining contrast and its connection to the esophagus immediately inferior and posterior to the larynx.
 
 
 
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