Zenker's Diverticulum–a Historical Review and Trends in Therapy

Abstract

More than 200 years have passed since the pulsion diverticulum of hypopharynx was first described. This paper reviews different opinions on its etiology over the centuries. The German pathologist F.A. von Zenker, who successfully pursued research on a variety of topics, is often associated with this diverticulum through his classical work from 1867 "Krankheiten des Oesophagus", which deals with the pathogenesis and clinical presentations of this herniation of the posterior mucosal wall. Numerous surgical techniques, which have been practised mainly during this century, are also reviewed. Different options of endoscopic surgery, which is presently the preferred approach at many medical centers, are described and discussed. Our own experience of endoscopic surgery in patients with Zenker's diverticulum is also presented.

Significant symptomatic relief after transoral endoscopic staple-assisted treatment of Zenker's diverticulum

“…Although the cause of Zenker's diverticula is controversially discussed, abnormal functioning of the upper esophageal sphincter is believed to be one of the main aspects of its pathogenesis [12,16]. Myotomy of the cricopharyngeal muscle is reported to be most effective in the treatment of hypopharyngeal diverticula [5,17].…”

Flexible endoscopic and surgical management of Zenker's diverticulum

“…Westrin et al described their 'neuromuscular dysfunction theory' with anatomical weakness of the posterior pharyngeal musculature above the CP and muscular dysfunction of the UES [23]. Age-related changes that may contribute to impaired pharyngeal swallowing include altered coup ling between the oral and pharyngeal phase of swallowing, delayed anterior movement of the hyoid bone and a decreased number of cells in Auerbach's plexus [24].…”

Dysphagia After Endoscopic Repair of Zenker's Diverticulum

“…Occurring in an area of natural weakness between the fibers of the inferior pharyngeal constrictor and the cricopharyngeus muscle known as Killian's dehiscence, a Zenker's diverticulum (ZD) is a well‐known clinical entity. Numerous methods of managing the diverticular sac have been tried over the course of the 20th century with varying levels of success 1 . Recently, endoscopic staple‐assisted diverticulectomy (ESD) has gained popularity as a treatment method because of the relatively high success levels and low complication rates 2 .…”