eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Bronchoesophagology

Zenker Diverticulum: Workup

Author: Joel A Ernster, MD, Active Staff, Penrose-St Francis Healthcare System; Active Staff, Memorial Health System; Clinical Instructor, University of Colorado Health Sciences Center
Contributor Information and Disclosures

Updated: Jan 17, 2008

Workup

Imaging Studies

  • The criterion standard of confirmatory evaluations is the barium swallow with videofluoroscopy. This study provides information about size, location, and character of the mucosal lining of the Zenker diverticulum (see Image 2). Certain radiographic features of the diverticulum neck may predict the likelihood of success of the endoscopic stapling approach. These features were reviewed by Tsikoudas.3

Diagnostic Procedures

  • Flexible endoscopic evaluation of swallowing (FEES) provides information that may suggest the presence of a Zenker diverticulum, but this test has not supplanted the barium swallow in most surgeons' practices. Pooling in the esophageal introitus may be ascertained in individuals with Zenker diverticulum by using cream or other readily visible forms of food in various consistencies. This test may help select patients for whom barium swallow is appropriate.
  • Rigid or flexible esophagoscopy is essential before surgical management to assess the nature of the mucosa of the Zenker diverticulum and to exclude the presence of SCC or carcinoma in situ. Care must be taken with rigid esophagoscopy to avoid perforating the Zenker diverticulum.
  • Esophageal or hypopharyngeal manometry does not add to the clinical workup.

Histologic Findings

A Zenker diverticulum is lined with stratified squamous epithelium with a thin lamina propria. No muscular layer exists. Fibrosis surrounding the diverticulum is common. The fibrotic tissue surrounding the diverticulum may limit the spread of any extravasated material from the diverticulum during endoscopic procedures and therefore reduce the likelihood of local abscess formation.

More on Zenker Diverticulum

Overview: Zenker Diverticulum
Workup: Zenker Diverticulum
Treatment: Zenker Diverticulum
Follow-up: Zenker Diverticulum
Multimedia: Zenker Diverticulum
References
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References

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Further Reading

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Keywords

Zenker diverticulum, pharyngeal diverticulum, ZD, Zenker diverticula, Killian triangle, cricopharyngeus muscle, CP muscle, diverticulectomy, open diverticulectomy, endoscopic diverticulectomy, CP myotomy, diverticulopexy, diverticulotomy

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Contributor Information and Disclosures

Author

Joel A Ernster, MD, Active Staff, Penrose-St Francis Healthcare System; Active Staff, Memorial Health System; Clinical Instructor, University of Colorado Health Sciences Center
Joel A Ernster, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Rhinologic Society, Colorado Medical Society, and Triological Society
Disclosure: Nothing to disclose.

Medical Editor

Lanny Garth Close, MD, Chair, Professor, Department of Otolaryngology-Head and Neck Surgery, Columbia University College of Physicians and Surgeons
Lanny Garth Close, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Physicians, American Laryngological Association, American Society for Head and Neck Surgery, and New York Academy of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Karen Hall Calhoun, MD, Chair, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Missouri
Karen Hall Calhoun, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Rhinologic Society, Society of University Otolaryngologists-Head and Neck Surgeons, and Texas Medical Association
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: UST Grant/research funds Consulting

 
 
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