Excision of Pharyngeal Diverticulum

Excision of Pharyngeal Diverticulum is a surgical procedure to remove Pharyngeal Diverticulum, also known as Zenker's diverticulum.

May 23, 2022

Excision of Pharyngeal Diverticulum is a surgical procedure to remove Pharyngeal Diverticulum, also known as Zenker's diverticulum. 

Some facts about Excision of Pharyngeal Diverticulum:

  • Pharyngoesophageal diverticulum is a pharyngeal pouch that is formed where the lower part of the throat and the upper part of the esophagus meet.
  • It is most common in older adults and can negatively affect quality of life if left untreated.
  • It can put a person at increased risk of aspiration and choking.
  • Zenker's diverticulum develops when the cricopharyngeus muscle, over-tightens, causing the throat above it to pouch out.
  • The pouch will enlarge overtime when the muscles below it tighten excessively.
  • Food can cause an obstruction as it can cought in this pouch or it can also make it difficult to take pills, which could get caught.
  • Difficulty swallowing, Bad breath, Chronic cough, A feeling of excessive phlegm or mucus in the throat, Sensation of a lump in the throat, Regurgitation of food (often hours after a meal), and Weight loss because eating is difficult are some of the symptoms of Zenker’s diverticulum.

Diagnosing Pharyngeal Diverticulum:

  • Diagnosis of Pharyngeal Diverticulum begin with a review of your symptoms and medical history.
  • Diagnostic endoscopy will be performed to view the top of the esophagus and surrounding structures. It is an outpatient procedure that is performed with local anesthetic and usually takes less than 5 minutes.
  • Chest X Ray or CT scan can also be done in patients with recurrent cough or aspiration symptoms.

Procedure for Excision of Pharyngeal Diverticulum:

  • Surgery may not be required for individuals with mild cases. Changes to your diet and eating habits, such as drinking water after meals or chewing food thoroughly, may be beneficial for them.
  • Surgery is recommended for severe cases.
  • The cricopharyngeal muscle is cut using a laser or stapler during this procedure which eliminates the pouch and allows food to pass through when swallowed.
  • Either a minimally invasive or open approach will be performed for Excision of Pharyngeal Diverticulum.
  • An external neck incision with CP myotomy (diverticulotomy), with or without pouch intervention is involved in the surgical approach.
  • A rigid or flexible endoscope will be used in the endoscopic approach. Only a diverticulotomy is involved, in which the septum between the esophageal lumen and the diverticulum and the CP muscle are severed to create a single channel.
  • Risk of adverse events including dental injury and perforation is involved in the endoscopic approach.
  • The risk of perforation increases with the use of a rigid diverticuloscope when there is insufficient protection of a small diverticular pouch by the dorsal esophageal wall.

Flexible endoscopic approach:
  • The septum (CP muscle) can be divided using a standard endoscopic retrograde cholangiopancreatography (ERCP) needle knife, as well as a HookKnife or HybridKnife dflexible endoscopic myotomy.
  • Additional devices such as monopolar and bipolar forceps, argon plasma coagulation and endoscopic scissors are also used.
  • The depth of the CP myotomy needed to treat the condition adequately should be determined as an insufficient myotomy will result in ongoing symptoms.
  • The advantage of flexible endoscopic approach over rigid endoscopy is by way of control, ease and therapeutic options