Definition
Esophageal diverticula are a condition in which sac-like projections form in the wall of the esophagus.
These projections may contain muscle tissue or only the mucous and submucosal layer of the esophagus.
They represent a relatively rare condition compared to the much more common diverticula of the colon.
Pathogenesis
The pathogenesis of esophageal diverticula can be multifactorial.
They typically develop due to a weakness in the muscular wall of the esophagus, which can be caused by inflammatory processes, chronic pressure, or neuromuscular disorders.
Diagnosis
The diagnosis of esophageal diverticula is usually made through endoscopies, such as esophagogastroduodenoscopy, which allows for direct visual assessment of the interior of the esophagus.
Radiographs or CT scans can also be used for more detailed assessment.
Treatment
The treatment of esophageal diverticula depends on the size, location, and severity of symptoms.
Small, asymptomatic diverticula usually do not require treatment. In more serious cases, treatments may include medication, dietary changes, or even surgery.
Medication may aim to reduce stomach acidity or improve esophageal motility.
Dietary changes are often recommended to reduce symptoms and prevent further worsening of the condition.
In cases of severe diverticula causing significant dysphagia or other dangerous symptoms, surgery may be recommended to remove the diverticulum or repair the esophagus.
Especially in recent years, with the development of endoscopic microsurgery, the endoscopic treatment of esophageal diverticula has become feasible.
Using new methods such as Z-POEM and others, patients can avoid large and difficult surgical procedures.
It is important for the management of esophageal diverticula to be done by a specialized doctor, who can provide personalized care depending on the condition and needs of the patient.
Epiphrenic diverticula are usually secondary to an oesophageal motility disorder, most often achalasia. They should not be confused with colonic diverticula, which are an entirely different condition.
- Zenker diverticulum arises above the cricopharyngeus muscle
- Epiphrenic diverticula are usually secondary to a motility disorder
- Small asymptomatic pouches are monitored, not treated
- Endoscopic septotomy is performed through the mouth, without external incision
Endoscopic treatment is described in practice in this case of Zenker diverticulum, where the septum was divided together with the cricopharyngeus fibres through the mouth, without an external incision.
Frequently asked questions
What causes an oesophageal diverticulum?
It depends on the site. A Zenker diverticulum arises above the cricopharyngeus muscle, which fails to relax, so the underlying problem is muscular rather than the pouch itself. Epiphrenic diverticula are usually secondary to an underlying motility disorder, most often achalasia, which is why manometry is performed before treatment.
Do all diverticula require treatment?
No. Small asymptomatic pouches are simply monitored. Treatment is indicated once there is dysphagia, regurgitation of undigested food, halitosis or weight loss, and above all when aspiration occurs, which in elderly patients carries a risk of pneumonia.
How is a Zenker diverticulum treated?
By endoscopic septotomy through the mouth, without an external incision. The septum between the pouch and the oesophagus is divided together with the cricopharyngeus fibres, which removes the barrier. The advantage over open surgery is greatest in elderly patients, and recovery is short.
Sources
- Weusten BLAM et al., Endoscopic management of gastrointestinal motility disorders part 1: ESGE Guideline. https://doi.org/10.1055/a-1160-5549
Content last updated: September 2026 (15/09/2026).
