Zenker’s Diverticulum: Endoscopic Surgical Management Options

Zenker diverticulum (ZD) is an uncommon pharyngo-esophageal outpouching that occurs in an area of muscular weakness at the junction of the inferior aspect of the inferior constrictor muscle and the cricophayngeus muscle (Killian dehiscence). As the diverticlulum enlarges it produces progressive dysphagia, regurgitation, and aspiration. The classic approach has been to do an open diverticulectomy in conjunction with a cricopharyngeal myotomy. While successful, the open approach is associated with significant cost, extended recovery time, and surgical morbidity. More recently the minimally invasive endoscopic diverticulostomy has been advocated as the procedure of choice to manage the majority of patients with ZD. This endoscopic technique consists of a trans-oral surgical procedure that divides the septum (party wall) between the ZD and the cervical esophagus. This mini-review will provide an overview of the current status of the use of the minimally invasive endoscopic technique with particular emphasis on the efficacy of the surgical procedure, safety of the procedure compared to open surgical techniques, and the cost savings associated with the minimally invasive technique. Frank R Miller* and Christine Taylor Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center San Antonio, USA