Treatment of Zenker’s diverticulum

What a Zenker diverticulum is

It is a pouch at the pharyngo-oesophageal junction, above the cricopharyngeus muscle. Food collects within it, producing progressive dysphagia, regurgitation of undigested food hours after a meal, halitosis and, in older patients, aspiration with a risk of pneumonia.

Why removing the pouch is not enough

The cause is not the pouch but the cricopharyngeus muscle failing to relax. Treatment therefore targets the septum between the pouch and the oesophagus, which contains the muscle fibres. Dividing it removes the barrier and the pouch no longer retains food.

Endoscopic septotomy

The procedure is performed through the mouth, without an external incision, under direct vision. This matters most in elderly patients, for whom open surgical access to the neck under general anaesthesia carries higher risk. Recovery is short and oral intake is restored quickly.

After the procedure

The material obtained is sent for histology, and it is that report rather than the endoscopic appearance that determines the next step. Recovery is short compared with surgery: eating and normal daily activities are generally resumed within a few days. Patients are given instructions on avoiding strenuous effort and on medications affecting coagulation, in particular anticoagulants and antiplatelet agents. Decisions about further treatment are usually taken by a multidisciplinary team, taking histology, staging and general condition into account.