Zenker's diverticulum natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ajay Gade MD[2]]

Overview

The development of Zenker's diverticulum (ZD) slowly starts as a oropharyngeal dysphagia progressing from solids to liquids, regurgitation of undigested food from the diverticular sac, chronic aspiration, halitosis, chronic cough, sensation of a lump in the throat, hoarseness, borborygmi. If left untreated, ZD may lead to complications such as aspiration pneumonia, bleeding from the diverticulum, ulceration of the diverticulum, compression of the trachea and esophageal obstruction with large diverticula, perforation, very rarely squamous cell carcinoma of the diverticulum. Patients who undergo surgery have a very low rate of recurrence for ZD.

Natural History

• Symptoms of Zenker's diverticulum slowly start as a
  • Oropharyngeal dysphagia progressing from solids to liquids
  • Regurgitation of undigested food from the diverticular sac
  • Pharyngeal stasis of secretion
  • Chronic aspiration
  • Halitosis
  • Chronic cough
  • Sensation of a lump in the throat
  • Hoarseness
  • Cervical borborygmi.

• The patient may note food on the pillow upon awakening in the morning.
• Although small diverticula may not cause symptoms, larger diverticula usually are symptomatic.
• Both the inability of the sphincter to fully open and the extrinsic compression from the pouch itself are likely to explain the dysphagia experienced by patients.
• In patients with very large diverticula, a gurgling swelling in the neck can occasionally be detected on palpation.

Complications

• Complications of the Zenker's diverticulum includes
• Aspiration pneumonia
• Bleeding of the diverticulum
• Ulceration of the diverticulum
• Compression of the trachea and esophageal obstruction with large diverticula
• Very rarely squamous cell carcinoma of the diverticulum
• Perforation of the diverticulum during the endoscopy. Hence scopes with side viewing should be used to prevent perforation.

Prognosis

Prognosis of ZD after the intervention is good, the recurrence of the diverticulum is very rare.