Zenker’s diverticulum occurs when a pouch forms at the back of your throat where your pharynx (voice box) meets your esophagus. This protruding pouch causes swallowing difficulties.
UPMC experts specialize in diagnosing and treating Zenker’s diverticulum using the most advanced minimally invasive and traditional surgical techniques.
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What Is Zenker's Diverticulum?
Zenker’s diverticulum occurs when a pouch forms at the back of your throat where your pharynx (voice box) and esophagus meet. The protruding pouch causes swallowing issues.
What are the stages of Zenker’s diverticulum?
There are several different ways to stage Zenker’s diverticulum based on the size and shape of the pouch.
Stages based on size and shape include:
- Stage 1 — A small, round pouch.
- Stage 2 — A pear-shaped pouch.
- Stage 3 — A long, finger-shaped pouch.
What size Zenker’s diverticulum requires surgery?
If your diverticulum is small and only causes mild symptoms, you may not need surgery. However, a larger diverticulum that causes moderate to severe symptoms may need surgical treatment.
How common is Zenker’s diverticulum?
Zenker’s diverticulum is a rare condition that affects less than 1% of the population. It occurs most often in people over age 60.
What causes Zenker’s diverticulum?
Doctors aren’t sure what causes Zenker’s diverticulum. However, the condition appears to be associated with increased pressure in the throat when swallowing.
Increased pressure while swallowing can happen when a circular muscle called your upper esophageal sphincter doesn’t open properly to allow food to pass through. This pressure causes a bulge through a weak spot in the back of your throat.
Zenker's diverticulum risk factors
Some people with the disorder have other issues with their esophagus, but not always.
You may be at increased risk for Zenker’s diverticulum if you:
- Are over age 60.
- Drink alcohol.
- Have a condition that causes increased pressure in your throat.
- Have gastroesophageal reflux disease (GERD).
- Smoke.
Complications of Zenker's diverticulum
If left untreated, your Zenker’s diverticulum pouch can become larger and worsen your symptoms.
Complications may include:
- Aspiration — The inhalation of food into your lungs.
- Aspiration pneumonia — Infection caused by food, saliva, or other swallowed particles getting stuck in your lungs.
- Bleeding.
- Blockage in your esophagus.
- Fistula — An abnormal connection between your esophagus and another organ.
- Malnutrition.
- Regurgitation of food.
- Squamous cell carcinoma — A type of esophageal cancer.
- Swallowing difficulties.
- Vocal cord paralysis.
How can I prevent Zenker's diverticulum?
There is nothing you can do to prevent Zenker’s diverticulum. However, getting early treatment for GERD, swallowing problems, and other symptoms can reduce your risk of experiencing serious complications.
What Are the Signs and Symptoms of Zenker's Diverticulum?
The main symptom of Zenker’s diverticulum is difficulty in swallowing food. Sometimes, food comes back up several minutes or hours after eating.
You may also experience Zenker’s diverticulum symptoms including:
- A feeling of mucous collecting in your throat.
- Bad breath.
- Feeling like you are choking.
- Hoarse voice.
When should I see a doctor about my Zenker’s diverticulum symptoms?
If you have symptoms of Zenker’s diverticulum, schedule an appointment with your doctor. Early treatment can reduce your risk of complications.
How Do You Diagnose Zenker's Diverticulum?
Your doctor may suspect you have Zenker’s diverticulum if you have symptoms that have not responded to other treatments and worsen over time.
What to expect during your visit
If your doctor suspects Zenker’s diverticulum, they will:
- Ask about your symptoms.
- Perform a physical exam.
- Order other tests.
- Review your health history and medications.
Tests to diagnose Zenker’s diverticulum
Tests to diagnose Zenker’s diverticulum include:
- Esophageal imaging (barium swallow study) — You will swallow a chalky liquid to help your esophagus appear more clearly on x-ray images.
- Esophageal manometry — Checks the pressure inside your esophagus.
- Upper gastrointestinal (GI) endoscopy — Your doctor will use a lighted tube with a camera called an endoscope to look inside your esophagus and stomach.
Zenker’s diverticulum prognosis
If your Zenker’s diverticulum is mild, you may not need treatment right away. If you are having moderate to severe symptoms, you may need surgery. Although surgery comes with a risk of complications, most people experience an improvement in symptoms after surgical treatment.
How Do You Treat Zenker's Diverticulum?
The goals of Zenker’s diverticulum treatment are to improve your ability to swallow and reduce your risk of complications. Treatment options may include:
Nonsurgical care for Zenker’s diverticulum
If your symptoms are mild, you may not need surgery right away. Your doctor may recommend monitoring your condition over time. Your doctor may also recommend making changes to your eating habits, such as eating easier-to-swallow foods and drinking between bites, to improve symptoms.
Surgery to treat Zenker’s diverticulum
UPMC surgeons perform both traditional and minimally invasive endoscopic surgery to treat Zenker’s diverticulum.
Minimally invasive endoscopic surgery for Zenker’s diverticulum
Minimally invasive surgery for Zenker’s diverticulum involves using a transoral (through-the-mouth) approach. Your surgeon will insert a flexible tube with a light and a camera at the end, called an endoscope, through your mouth and into your esophagus. Your surgeon will use small surgical instruments inserted through the tube to remove your diverticulum.
Compared to traditional open surgery, the advantages of minimally invasive surgery for Zenker’s diverticulum include:
- Earlier return to normal swallowing and eating.
- Quicker recovery time.
- Shortened hospital stay.
Traditional open surgery for Zenker’s diverticulum
If you are not able to have minimally invasive surgery, your doctor may recommend a traditional open surgical procedure to treat Zenker’s diverticulum. During the procedure, your surgeon will make an incision in your neck and perform a diverticulectomy to remove your diverticulum.
If removal isn’t possible, your surgeon may also perform a diverticulopexy or a diverticular inversion to change the position of your diverticulum to improve your ability to swallow.
Why Choose UPMC for Zenker's Diverticulum Care?
When you choose UPMC for Zenker’s diverticulum care, you will receive:
- Access to board-certified specialists — Our specialists are experienced in caring for people with Zenker’s diverticulum and related complications.
- Expert diagnosis and personalized care — Our team will develop a customized treatment plan to reduce your risk of complications and improve your quality of life.
- A full range of treatment options — We use the latest minimally invasive and traditional surgical techniques to provide comprehensive Zenker’s diverticulum care.
