Zenker’s diverticulum

Zenker’s diverticulum is a pseudodiverticulum of the esophagus that forms in the Killian’s triangle, between the inferior pharyngeal constrictor and the cricopharyngeus (CP) muscle. The etiology of Zenker’s diverticulum has been a topic of much debate, but increased intraluminal pressure from CP muscle dysfunction is most often implicated. While some individuals with this condition may be asymptomatic, the most common symptom in affected patients is oropharyngeal dysphagia and regurgitation of undigested food. Definitive diagnosis is achieved via radiologic swallow study or esophagoscopy, allowing visualization of the outpouching above the CP muscle. Curative treatment consists of surgery: both open and endoscopic methods exist, though the endoscopic approach is currently more widely used. The open approach is typically reserved for cases with difficult endoscopic visualization or very large diverticulum. Both methods have strengths and shortcomings, and the appropriate approach must be tailored to the individual patient.