Materiały źródłowe

• #1 Zenker’s diverticulum – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/zenkers-diverticulum/diagnosis-treatment/drc-20568846

  To diagnose Zenker’s diverticulum, a healthcare professional, often an ear, nose and throat (ENT) specialist, does a physical exam and asks about your symptoms. […] The test most often done to diagnose Zenker’s diverticulum is a barium swallow. In this test, a specialist takes a series of X-rays of the digestive tract after you swallow a liquid that coats the walls of the digestive tract. The liquid, called barium sulfate, makes the digestive tract easier to see on X-ray.

• #1 Zenker’s diverticulum: aetiopathogenesis, symptoms and diagnosis. Comparison of operative methods

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4027817/

  Zenkers diverticulum manifests itself with characteristic symptoms and signs. The first and most common symptom is a gradually increasing dysphagia. In consequence of regurgitations the aspiration of ingesta into the bronchial tree may appear and subsequent dyspnea due to Mendelsons syndrome. Characteristic are loud swallowing of liquids, cough and hoarseness. Over time the diverticulum grows and patients complain of dysphagia due to esophagus constriction by the filled diverticulum. Voice alteration and halitosis may also occur. […] The diagnosis is based on a radiogram with barite that reveals a diverticulum filled with contrast on the side of the esophagus. Esophagogastroduodenoscopy may be useful in ZD and operation conditions assessment. Another valuable, but technically difficult examination is UES manometry. Manometry is not useful in the routine diagnostic approach due to, among others, catheter dislocation during examination impeding the proper analysis.

• #1 Zenker Diverticulum: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/836858-overview

  Special maneuvers to dislodge food. […] Coughing after eating. […] Aspiration of organic material. […] Unexplained weight loss. […] Fetor ex ore (halitosis). […] Borborygmi in the neck. […] Symptoms may last from months to years. […] The most common life-threatening complication in patients with a Zenker diverticulum is aspiration. […] Other complications include massive bleeding from the mucosa or from fistulization into a major vessel, esophageal obstruction, and fistulization into the trachea. […] Squamous cell carcinoma (SCC) within a Zenker diverticulum is extremely rare, occurring in 0.3% of Zenker diverticula worldwide. […] A Mayo Clinic review suggests an incidence of 0.48% in the United States. […] The criterion standard for confirmatory evaluations is the barium swallow with videofluoroscopy.

• #1 Zenker Diverticulum: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/836858-overview

  This study provides information about the size, location, and character of the mucosal lining of the Zenker diverticulum. […] Patients with symptomatic disease usually have a posterior midline pouch greater than 2 cm in diameter arising just above the CP muscle. […] No other study is required if no other abnormality is present. […] Esophageal manometry is indicated if the contrast study suggests that achalasia or another esophageal motility disorder is present.

• #1 Zenker’s diverticulum – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/zenkers-diverticulum/symptoms-causes/syc-20568839

  Zenker’s diverticulum is diagnosed mainly by what’s called a swallow study. […] The upper part of the swallow is called a video fluoroscopic swallow study. […] The second part of the swell study is really important, though, and that’s called the esophagram, where they look at the esophagus, and that’s also called a barium swallow. […] The chance of recurrence after Zenker’s surgery really depends on the approach and the procedure and the surgeon who’s doing it. […] Overall, the recurrence rate for certain procedures such as the flexible approach, the endoscopic stapler approach and the harmonic scalpel approach are higher. […] The latest research shows around 15% or more than the typical laser approach we use here with a rigid laser or the open neck approach. Those have lower recurrence rates.

• #1 Zenker diverticulum | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/zenker-diverticulum-1?lang=us

  Zenker diverticulum, also known as a pharyngeal pouch, is a posterior outpouching of the hypopharynx, just proximal to the upper esophageal sphincter through a weakness in the muscle layer called the Killian dehiscence. […] Ideally, a barium swallow examination is performed, which may show: a diverticulum arising from the midline of the posterior wall of the distal pharynx near the pharyngoesophageal junction. […] The pouch is best identified during swallowing and is best seen on the lateral view, on which the diverticulum is typically noted at the C5-6 level. […] Since ~90% of patients with a Zenker diverticulum have a hiatal hernia and gastro-esophageal reflux, the distal esophagus should also be evaluated.

• #1 Zenker’s Diverticulum: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/zenkers-diverticulum

  In Zenkers diverticulum, you have a pouch in the back of your throat. […] Healthcare providers may do the following tests to diagnose Zenkers diverticulum: Esophagram test, Upper endoscopy, Esophageal manometry. […] If Zenkers diverticulum causes serious complications like malnutrition or aspiration pneumonia, or it causes other bothersome symptoms, your healthcare provider may recommend surgery. […] Zenkers diverticulum surgery involves removing, moving or altering the pouch in your throat so it doesnt trap food. […] Most people recover within a few days to a couple of weeks. […] The outlook is good, but Zenkers diverticulum may come back after surgery.

• #1 Zenker’s Diverticulum – Head & Neck Surgery | UCLA Health

  https://www.uclahealth.org/medical-services/head-neck-surgery/conditions-treated/zenkers-diverticulum

  Zenker’s Diverticulum is an esophageal pouch that develops in the upper esophagus that causes debilitating dysphagia (difficulty swallowing) and regurgitation of food. […] The Head and Neck Surgeons at the UCLA Swallowing Disorders Center will diagnose Zenker’s diverticulum based on a combination of your dysphagia history as well as swallow evaluation tests such as barium esophagram, videofluoroscopic swallow study, fiberoptic endoscopic evaluation of swallowing (FEES), and transnasal esophagoscopy. […] With these techniques the diagnosis can be made with 100% accuracy. […] It is very important to distinguish a Zenker’s diverticulum from a Mid-esophageal diverticulum or a Killian-Jamieson (KJ) diverticulum. Office-based transnasal esophagoscopy is often used to distinguish between these possibilities if diagnosis is unclear based on radiological studies. […] The UCLA Swallowing Disorders Center is at the forefront of diagnosis and surgical treatment of Zenker’s Diverticulum.

• #1 Zenker’s diverticulum: Symptoms, causes, and surgery

  https://www.medicalnewstoday.com/articles/zenker-diverticulum

  Doctors may use certain tests to find out whether a person has ZD and to rule out other conditions with similar symptoms. These conditions will include: […] Below are two tests a doctor may use to diagnose ZD. Both involve investigating the upper digestive tract, which consists of the following structures: […] A barium swallow with videofluoroscopy involves swallowing a substance called barium to help the upper digestive tract show up more clearly on X-ray images. The test allows doctors to determine the size, function, and condition of the different parts of the upper digestive system. […] An upper endoscopy involves inserting an endoscope a long, thin, and flexible tube into a persons upper digestive tract. The tube has a camera at the end and allows the doctor to visually examine the different parts of the upper digestive system.

• #1 Esophageal Diverticula Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/174402-workup

  Most laboratory studies are not helpful in the diagnosis. […] Radiographic studies and upper GI endoscopy detect many esophageal diverticula incidentally because esophageal diverticula often are asymptomatic. […] Barium swallow is a useful study in patients who are symptomatic and have mid esophageal and epiphrenic diverticula. Diagnosis of Zenker diverticulum is made best using barium swallow, which should include lateral views of the pharyngoesophageal junction. It also can be made using careful upper endoscopy by an experienced endoscopist. […] Endoscopy is unnecessary in a patient with Zenker diverticula if the diagnosis has been made using barium radiograph. If flexible upper GI endoscopy is needed in a patient with a known Zenker diverticulum, it should be performed with caution, with the endoscope being passed under direct visualization to minimize the risk of perforation.

• #1 Zenker’s Diverticulum | Tampa General Hospital 

  https://www.tgh.org/institutes-and-services/conditions/zenkers-diverticulum

  Esophageal manometry A physician will guide a narrow, flexible, pressure-sensitive tube (catheter) through a numbed nostril and into the esophagus. Using the catheter, the physician will measure the pressure inside the esophagus while the patient sips varying amounts of water. […] Imaging studies In complex cases, a physician may order advanced imaging tests, such as computed tomography (CT) or magnetic resonance imaging (MRI) scans, to obtain detailed views of the esophagus and surrounding structures.

• #1 Zenker’s diverticulum – ENT Info

  https://www.entinfo.nz/zenkers-diverticulum/

  Barium swallow test is widely used to confirm the diagnosis of ZD. […] In addition, ZD may be diagnosed using ultrasonography (USS). This method is useful to differentiate ZD from other conditions such as thyroid nodules or other causes of neck mass. It is also an alternative option for those who cannot tolerate barium swallow or have difficulty swallowing. […] Upper endoscopy is not required to establish ZD diagnosis but can provide useful information such as ruling out an associated cancer. The process involves insertion of a flexible, narrow tube with a camera attached into the patients mouth and into the digestive tract for direct visualization. […] In patient with ZD, posterior outpouching of the esophagus is seen at the level of sternoclavicular joint during barium esophagography. It can be combined with dynamic continuous fluoroscopy to allow better visualization of ZD as static images may be insufficient in those with small diverticulum and provide evidence of overflow and aspiration. […] During USS, findings such as increase in size, reduction of margins definition and heterogenous echogenicity observed upon swallowing water are suggestive of ZD.

• #1 A Patient With a Zenker’s Diverticulum Showing Symptoms Similar to Acute Coronary Syndrome | Oyama | Journal of Medical Cases

  https://www.journalmc.org/index.php/JMC/article/view/2311/1721

  A 61-year-old man with no significant medical history was admitted to our hospital because of upper chest pain and discomfort. […] Further questioning after coronary angiography revealed that patients symptoms had gotten worse soon after swallowing a piece of sushi without chewing. Computed tomography of the chest revealed air particles outside the posterior hypopharynx wall, and subsequent esophagography showed Zenkers diverticulum (ZD) of about 1 cm in diameter. […] Physicians should know that esophageal diseases, including ZD, might show symptoms mimicking ACS, and that not obtaining a detailed clinical history can lead to misdiagnosis. […] Esophagography is still the mainstay of definite diagnosis of ZD and can determine its size and location. […] Endoscopy has limited value in the diagnosis of ZD; however, endoscopic examination of ZD is necessary to rule out ZD-associated cancer, which may develop as a result of chronic irritation and inflammation due to food or liquid stasis.

• #1 Zenker’s diverticulum differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Zenker%27s_diverticulum_differential_diagnosis

  Zenker’s diverticulum must be differentiated from other diseases that cause dysphagia such as reflux esophagitis, esophageal carcinoma, systemic sclerosis, esophageal spasm, pseudoachalasia, stroke, esophageal candidiasis and Chagas disease. […] Zenker’s diverticulum […] shows out-pouching over the posterior esophagus in the Killian’s triangle. […] Barium esophagography […] is used for diagnosis.

• #1 Zenker Diverticulum – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499996/

  Zenker diverticulum develops in the hypopharynx, typically between the cricopharyngeus muscle and the inferior pharyngeal constrictor muscle at the level of cervical vertebrae 5 and 6. […] This activity reviews the evaluation and management of Zenker diverticulum and highlights the role of the interprofessional team in the recognition and management of this condition. […] Explain when a barium fluoroscopic evaluation should be considered in patients presenting with dysphagia. […] Barium swallow with videofluoroscopy provides information regarding its size, location, and character of the mucosal lining, and diagnoses the condition. […] Staging of the Zenker diverticulum is imperative to the overall evaluation. […] The Lahey, Mortons, and Van Overbeek staging systems are used for evaluation of a Zenker’s diverticulum.

• #1 Zenker Diverticulum – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499996/

  Barium swallow with videofluoroscopy is the radiographic methods used for staging. […] The prognosis for these patients is dependant on which surgical procedure was performed. […] Proper follow-up is imperative to minimizing post-operative complications and infections. […] An interprofessional approach to Zenker diverticulum is necessary as the diagnosis can be delayed because of the vague symptoms. […] Patients admitted with a diagnosis of Zenker diverticulum need to be looked after an interprofessional team of healthcare professionals because there are many treatment options. […] The key is to have an experienced surgeon or endoscopist.

• #1 The Endoscopic Management of Zenker’s Diverticulum: A Comprehensive Review

  https://www.mdpi.com/2075-4418/14/19/2155

  Although there is not a universally accepted and specific symptom score for the clinical evaluation of ZD patients, different scores have been used. […] As dysphagia represents the most frequent symptom, along with EGD and esophagogram, there is increasing evidence supporting the use of the functional lumen imaging probe (FLIP) for impedance planimetry of the UES in the diagnostic and peri-operative work-up. […] Flexible endoscopic approaches have been developed over the past few decades as safe and effective alternatives to surgery for ZD treatment. […] FESD has demonstrated high clinical efficacy, with CS rates ranging from 90% to 100% across multiple studies. […] The outcomes of Z-POEM have been evaluated in several studies and meta-analyses. […] Managing ZD with a short septum presents significant challenges for endoscopists.

• #1 The Endoscopic Management of Zenker’s Diverticulum: A Comprehensive Review

  https://www.mdpi.com/2075-4418/14/19/2155

  The key feature of POES lies in performing the mucosal entry directly on the septum, rather than 3 cm above it. […] The endoscopic management of ZD has evolved significantly in recent years. […] While surgery has traditionally been the standard for ZD, endoscopic techniques now provide comparable, if not superior, clinical outcomes with a significantly lower risk of AEs. […] Despite the significant progress made in the field, several aspects of the endoscopic treatment of ZD still require further research and development. […] Standardizing the use of validated, ZD-specific symptom scores across studies would enable more meaningful comparisons of different endoscopic techniques and their outcomes.

• #1 Zenker’s Diverticulum | Mount Sinai – New York

  https://www.mountsinai.org/locations/grabscheid-voice-swallowing-center/conditions/zenkers-diverticulum

  Zenker’s diverticulum is an outpouching that occurs at the junction of the lower part of the throat and the upper portion of the esophagus. […] At The Grabscheid Voice and Swallowing Center, our interdisciplinary team of speech language pathologists and laryngologists are experienced in evaluation and management of patients with Zenker’s diverticulum. During your consultation, you will undergo complete swallow evaluation to determine which types of interventions will best help relieve your symptoms. […] Patients with difficulty swallowing should have a thorough evaluation beginning with a history specifically attempting to identify the symptoms described above. These symptoms are considered diagnostic. […] If the remainder of the pharynx is healthy and does not collect secretions, then it is likely that patients will do well with surgical elimination of the diverticulum.

• #1 Zenker’s Diverticulum | Southern California, Orange County, Otolaryngology ENT

  https://throatdisorder.com/zenkers-diverticulum/

  Zenkers Diverticulum: What is it and How do you Treat it? […] Diagnosis of Zenkers Diverticulum: […] Medical History: Focusing on issues such as weight loss, avoidance of eating, difficulty eating including regurgitation or aspiration of food. […] Physical Exam: Although a Zenkers Diverticulum can be 15cm or more, it is rarely felt on physical exam. Diagnosis is achieved through detailed history taking and imaging studies (discussed below). […] Imaging Studies: Although endoscopic evaluation is increasingly being used to diagnose esophageal diverticula, the barium swallow is still considered the most effective way to diagnose a Zenkers diverticulum. The patient is given a barium solution to drink, the solution fills the pouch in the esophageal wall, and it can be seen on an X-ray. This study provides information about the size, location, and character of the mucosal lining of the diverticulum.

• #1 Zenker’s Diverticulum | Tampa General Hospital 

  https://www.tgh.org/institutes-and-services/conditions/zenkers-diverticulum

  Proper diagnosis of a Zenkers diverticulum is essential for effective treatment. […] The primary diagnostic techniques include: […] Clinical evaluation A physician will assess the symptoms and perform a physical examination and medical history review. […] Barium swallow study As X-rays are continually captured, the patient will swallow a barium contrast solution, which will coat the esophagus and enhance the clarity of the images. This can help the physician visualize the diverticulum (if present) and assess its size and location. […] Upper endoscopy A physician will guide a flexible tube with a miniature camera attached to the end (endoscope) through the mouth and into the esophagus. Using the endoscope, the physician can gain a direct view of the Zenkers diverticulum (if present) and assess its severity.

• #1 Zenker’s Diverticulum | Mount Sinai – New York

  https://www.mountsinai.org/locations/grabscheid-voice-swallowing-center/conditions/zenkers-diverticulum

  Once the Zenker’s diverticulum is identified and it is determined that it is the cause of the swallowing difficulty, then treatment options can be considered. Surgery is the standard of treatment but, for older or infirmed patients, life style and dietary modifications can be considered. […] Patients with preserved pharyngeal strength and swallow reflexes are excellent candidates for surgical correction. Since the main reason the diverticulum forms is failure of relaxation of the CP muscle, surgeons have found that surgical intervention is most effective when it targets cutting the CP muscle.

• #1 Zenker’s diverticulum: etiopathogenesis, symptoms and diagnosis. Comparison of operative methods

  https://www.termedia.pl/Zenker-s-diverticulum-etiopathogenesis-symptoms-and-diagnosis-Comparison-of-operative-methods,41,21701,1,0.html

  Zenkers diverticulum manifests itself with characteristic symptoms and signs. The first and most common symptom is a gradually increasing dysphagia. In consequence of regurgitations the aspiration of ingesta into the bronchial tree may appear and subsequent dyspnea due to Mendelsons syndrome. Characteristic are loud swallowing of liquids, cough and hoarseness. Over time the diverticulum grows and patients complain of dysphagia due to esophagus constriction by the filled diverticulum. Voice alteration and halitosis may also occur. The diagnosis is based on a radiogram with barite that reveals a diverticulum filled with contrast on the side of the esophagus. Esophagogastroduodenoscopy may be useful in ZD and operation conditions assessment. Another valuable, but technically difficult examination is UES manometry. Manometry is not useful in the routine diagnostic approach due to, among others, catheter dislocation during examination impeding the proper analysis. […] The possibility of its presence should always be considered in clinical practice not only due to the severe consequences, but also due to the existence of effective therapeutic methods when diagnosed.

• #1 What Is the Best Technique for Diagnosing Esophageal Diverticulum? – Page 5 of 5 – ENTtoday

  https://www.enttoday.org/article/what-is-the-best-technique-for-diagnosing-esophageal-diverticulum/5/?singlepage=1

  Otolaryngologists-head and neck surgeons would most likely identify Mr. Landiss symptoms as suspicious for esophageal diverticulum. […] The gold standard remains the barium swallow, asserted Dr. Postma. […] At our institution, when we are referred patients who are demonstrating symptoms of dysphagia and in whom a suspicion for esophageal diverticulum is high, we typically order a barium swallow. […] Dr. Chhetri and his research assistant Jennifer Long, MD, PhD, presented results of a retrospective cohort review, in which they reported that the finding of esophagopharyngeal reflux (EPR) when performing FEES has a high sensitivity and specificity for the presence of an esophageal diverticulum. […] Dr. Hillel said that he recommends the standard barium swallow for definitive diagnosis and ease of surgical planning.

• #1 Zenker’s Diverticulum | UCI Head and Neck Surgery – UCI ENT Doctors – Otolaryngologists

  https://uciheadandneck.com/clinical-specialties/zenkers-diverticulum/

  The diagnosis of Zenkers diverticulum is normally confirmed following a visual inspection of the affected area using an endoscope or a swallowing study known as a modified barium swallow study or esophagram. […] A Zenkers diverticulum can be corrected through surgery. This involves cutting the cricopharyngeus muscle which causes constriction. This procedure allows the food to pass through to the esophagus easily. […] If the diverticulum is small, the preferred surgical technique is a minimally invasive approach in which the pouch is accessed through the mouth. The surgeon then uses a surgical stapler or laser to cut the cricopharyngeus muscle. […] Patients with a large diverticulum may require an external approach. This involves making a cut through the neck in order to remove the pouch and cut the cricopharyngeus muscle.

• #2 Zenker Diverticulum – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499996/

  Zenker diverticulum develops in the hypopharynx, typically between the cricopharyngeus muscle and the inferior pharyngeal constrictor muscle at the level of cervical vertebrae 5 and 6. […] This activity reviews the evaluation and management of Zenker diverticulum and highlights the role of the interprofessional team in the recognition and management of this condition. […] Explain when a barium fluoroscopic evaluation should be considered in patients presenting with dysphagia. […] Barium swallow with videofluoroscopy provides information regarding its size, location, and character of the mucosal lining, and diagnoses the condition. […] Staging of the Zenker diverticulum is imperative to the overall evaluation. […] The Lahey, Mortons, and Van Overbeek staging systems are used for evaluation of a Zenker’s diverticulum.

• #2 Zenker Diverticulum: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/836858-overview

  The criterion standard for confirmatory evaluation of Zenker diverticulum is a barium swallow with videofluoroscopy. […] Esophageal manometry is indicated if the contrast study suggests that achalasia or another esophageal motility disorder is present. […] Rigid/flexible esophagoscopy is essential before surgical management to assess the nature of the mucosa of the Zenker diverticulum and to exclude the presence of SCC or carcinoma in situ. […] The history strongly suggests the diagnosis of Zenker diverticulum. […] The combination of the following signs and symptoms is nearly pathognomonic for the condition: Dysphagia – Most patients (98%) present with some degree of dysphagia. […] Regurgitation of undigested food hours after eating. […] Sensation of food sticking in the throat.

• #2 Zenker’s Diverticulum | Mount Sinai – New York

  https://www.mountsinai.org/locations/grabscheid-voice-swallowing-center/conditions/zenkers-diverticulum

  Zenker’s diverticulum is an outpouching that occurs at the junction of the lower part of the throat and the upper portion of the esophagus. […] At The Grabscheid Voice and Swallowing Center, our interdisciplinary team of speech language pathologists and laryngologists are experienced in evaluation and management of patients with Zenker’s diverticulum. During your consultation, you will undergo complete swallow evaluation to determine which types of interventions will best help relieve your symptoms. […] Patients with difficulty swallowing should have a thorough evaluation beginning with a history specifically attempting to identify the symptoms described above. These symptoms are considered diagnostic. […] If the remainder of the pharynx is healthy and does not collect secretions, then it is likely that patients will do well with surgical elimination of the diverticulum.

• #2 Zenker’s Diverticulum | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/z/zenkers-diverticulum.html

  A barium swallow is the most effective way to diagnose a Zenker’s diverticulum. The barium solution fills the pouch in the esophageal wall so that it can be seen on an X-ray.

• #2 Zenker’s Diverticulum – Esophageal Health | UCLA Health

  https://www.uclahealth.org/medical-services/gastro/esophageal-health/diseases-we-treat/zenkers-diverticulum

  Zenker’s diverticulum is diagnosed during upper endoscopy (EGD) or esophagram (aka barium swallow), or a modified barium swallow study (aka videofluoroscopic swallow study) (see figure). These tests complementary during investigation of swallowing problems. […] The goal of treatment of Zenkers diverticulum is to relieve the obstruction to swallowing caused by the tight UES and eliminate the preferential passage and accumulation of swallowed material into the diverticulum. For a large or complicated diverticulum, open neck surgery may be necessary to remove the diverticulum sac (Zenkers diverticulectomy), but most patients with symptomatic Zenkers diverticulum are now treated in a minimally invasive endoscopic approach. Endoscopic cricopharyngeal myotomy (diverticulotomy) has become a primary and important means of treatment of Zenkers diverticulum. This procedure involves cutting the tight UES muscle and the party wall between the esophagus and the pouch to eliminate the obstruction. This procedure remodels the anatomy of the esophagus relative to the diverticulum so that swallowed material easily passes from the diverticulum into the esophagus.

• #2 Zenker diverticulum | Radiology Case | Radiopaedia.org

  https://radiopaedia.org/cases/zenker-diverticulum-7?lang=us

  During swallowing an out-pouching of the posterior hypopharyngeal wall is clearly visualized at the level C5-C6, right above the upper esophageal sphincter. This is compatible with a Zenker’s diverticulum. […] The pouch is characterized by a narrow neck entrapping some barium after the swallowing. […] This is a classical esophageal swallow imaging of Zenker’s diverticulum.

• #2 Zenker’s Diverticulum: Symptoms and Treatment

  https://www.webmd.com/digestive-disorders/what-is-zenkers-diverticulum

  If your doctor thinks that you might have Zenkers diverticulum, they will most likely order a test called an esophagram, or barium swallow. A contrast, barium, is used to fill the pouch so that your doctor can see it in pictures. This test helps your doctor better understand what is causing your difficulty when swallowing. […] Another test for diagnosing Zenkers diverticulum is an upper endoscopy. An endoscopy gives your doctor a look at the pouch and how big it is. […] The last possibility when it comes to diagnosing Zenkers diverticulum is esophageal manometry. This is a test that studies the pressure inside of your esophagus.

• #2 Zenker’s diverticulum: Symptoms, causes, and surgery

  https://www.medicalnewstoday.com/articles/zenker-diverticulum

  This test is useful for ruling out other causes of symptoms and identifying signs of ZD, such as food buildup in the diverticulum or scar tissue around the diverticulum. […] Individuals with moderate or severe ZD may require surgery to correct the diverticulum. […] Surgery for ZD is generally safe and effective, though there may be certain risks. A person should discuss the potential benefits and risks with their doctor before deciding to undergo surgery.

• #2 Zenker's Diverticulum – Diagnosis & Treatment

  https://www.upmc.com/services/esophageal-lung-surgery-institute/conditions/benign-esophageal-diseases/zenkers-diverticulum

  Zenkers diverticulum is a pouch that forms at the back of the throat where the voice box (pharynx) and esophagus meet. The primary symptom is difficulty in swallowing food; sometimes food comes back up several minutes or hours after eating. […] Tests for Diagnosing Zenkers Diverticulum […] Barium esophagography provides an anatomic road for evaluation of the swallowing disorder. Upper endoscopy examines the esophageal mucosa and helps identify conditions that may mimic Zenkers diverticulum. Esophageal manometry studies the pressure inside the esophagus.

• #2 Zenker’s diverticulum: etiopathogenesis, symptoms and diagnosis. Comparison of operative methods

  https://www.termedia.pl/Zenker-s-diverticulum-etiopathogenesis-symptoms-and-diagnosis-Comparison-of-operative-methods,41,21701,1,0.html

  Zenkers diverticulum manifests itself with characteristic symptoms and signs. The first and most common symptom is a gradually increasing dysphagia. In consequence of regurgitations the aspiration of ingesta into the bronchial tree may appear and subsequent dyspnea due to Mendelsons syndrome. Characteristic are loud swallowing of liquids, cough and hoarseness. Over time the diverticulum grows and patients complain of dysphagia due to esophagus constriction by the filled diverticulum. Voice alteration and halitosis may also occur. The diagnosis is based on a radiogram with barite that reveals a diverticulum filled with contrast on the side of the esophagus. Esophagogastroduodenoscopy may be useful in ZD and operation conditions assessment. Another valuable, but technically difficult examination is UES manometry. Manometry is not useful in the routine diagnostic approach due to, among others, catheter dislocation during examination impeding the proper analysis. […] The possibility of its presence should always be considered in clinical practice not only due to the severe consequences, but also due to the existence of effective therapeutic methods when diagnosed.

• #2 Zenker’s diverticulum

  https://gastroinflorida.com/esophageal-disorder/zenkers-diverticulum/

  The diagnosis of zenker diverticulum is best done with Barium Swallow studies, typically combined with dynamic continuous fluoroscopy while the patient is swallowing the contrast. It is also the most initial diagnostic test that your doctor will do when they suspect zenkers diverticulum. […] In patient who have difficulty swallowing, an alternative approach using transcutaneous ultrasound, especially when trying to differentiate the causes of neck mass such as thyroid mass versus neck mass from zenkers diverticulum. […] Diagnostic procedures that are contraindicated in patients who are suspected or well known for zenkers diverticulum are nasogastric tube (NGT) and Esophagogastroduodenoscopy (EGD) due to risk of perforation from blind introduction of instrument.

• #2 Zenker’s diverticulum (patient information) – wikidoc

  https://www.wikidoc.org/index.php/Zenker%27s_diverticulum_(patient_information)

  While it may be asymptomatic, Zenker diverticulum often causes clinical manifestations such as the following: […] An x-ray (barium esophagogram) is the best initial imaging study in a patient suspected with Zenker’s Diverticulum (ZD). Findings on an x-ray (barium esophagogram) suggestive of esophageal diverticulum associated with ZD appear as thin projections on the anterior esophageal wall over the Killian’s triangle. […] Zenker’s diverticulum (ZD) appears as an out-pouching sac on the CT scan over the posterior esophagus in the Killian’s triangle, a point of weakness in the muscular wall of the hypopharynx surrounded by the cricopharyngeal sphincter and oblique fibers of the inferior constrictor of the pharyngeal muscle. […] Zenker’s diverticulum (ZD) appears as an out-pouching sac on the MRI scan over the posterior esophagus in the Killian’s triangle, a point of weakness in the muscular wall of the hypopharynx surrounded by the cricopharyngeal sphincter and oblique fibers of the inferior constrictor of the pharyngeal muscle. The sac is filled with, fluid, food, contrast materials. […] The ultrasonographic findings of Zenker’s divericulum (ZD) includes iso-echoic or hypo-echoic mass with internal or peripheral echogenic foci and a boundary hypo-echoic zone at the posterior portion of the thyroid gland.

• #2 A Patient With a Zenker’s Diverticulum Showing Symptoms Similar to Acute Coronary Syndrome | Oyama | Journal of Medical Cases

  https://www.journalmc.org/index.php/JMC/article/view/2311/1721

  A 61-year-old man with no significant medical history was admitted to our hospital because of upper chest pain and discomfort. […] Further questioning after coronary angiography revealed that patients symptoms had gotten worse soon after swallowing a piece of sushi without chewing. Computed tomography of the chest revealed air particles outside the posterior hypopharynx wall, and subsequent esophagography showed Zenkers diverticulum (ZD) of about 1 cm in diameter. […] Physicians should know that esophageal diseases, including ZD, might show symptoms mimicking ACS, and that not obtaining a detailed clinical history can lead to misdiagnosis. […] Esophagography is still the mainstay of definite diagnosis of ZD and can determine its size and location. […] Endoscopy has limited value in the diagnosis of ZD; however, endoscopic examination of ZD is necessary to rule out ZD-associated cancer, which may develop as a result of chronic irritation and inflammation due to food or liquid stasis.

• #2 Dysphagia – Zenker’s diverticulum – Medizinonline

  https://medizinonline.com/en/dysphagia-zenkers-diverticulum/

  Zenkers diverticulum causes passenger disturbances in the pharyngoesophageal junction. Regurgitation and regurgitation of undigested food occur frequently. […] Radiologic evaluation may include procedures with contrast of the esophagus, as well as computed tomography or magnetic resonance imaging studies. […] The tentative diagnosis of Zenkers diverticulum results from symptoms summarized in Overview 1. […] Diagnostic imaging may be performed by X-ray examination with contrast of the esophagus, computed tomography or magnetic resonance imaging. […] X-ray examinations are very effective in detecting Zenkers diverticulum. The porridge swallow, the images with contrast of the upper digestive tract with barium sulfate, can visualize the diverticulum very well. […] Computed tomography, similar to MRI of the pharyngeal wall, can delineate adjacent fluid-containing and also air-containing structures. […] Magnetic resonance imaging is not used for primary diagnosis of Zenkers diverticulum. Detection may be considered incidental if cystic lesions with fluid levels are demarcable in the posterior visceral space just caudal to the pharyngoesophageal junction.

• #2 Zenker’s diverticulum: Symptoms, causes, and surgery

  https://www.medicalnewstoday.com/articles/zenker-diverticulum

  Doctors may use certain tests to find out whether a person has ZD and to rule out other conditions with similar symptoms. These conditions will include: […] Below are two tests a doctor may use to diagnose ZD. Both involve investigating the upper digestive tract, which consists of the following structures: […] A barium swallow with videofluoroscopy involves swallowing a substance called barium to help the upper digestive tract show up more clearly on X-ray images. The test allows doctors to determine the size, function, and condition of the different parts of the upper digestive system. […] An upper endoscopy involves inserting an endoscope a long, thin, and flexible tube into a persons upper digestive tract. The tube has a camera at the end and allows the doctor to visually examine the different parts of the upper digestive system.

• #2 The Endoscopic Management of Zenker’s Diverticulum: A Comprehensive Review

  https://www.mdpi.com/2075-4418/14/19/2155

  Although there is not a universally accepted and specific symptom score for the clinical evaluation of ZD patients, different scores have been used. […] As dysphagia represents the most frequent symptom, along with EGD and esophagogram, there is increasing evidence supporting the use of the functional lumen imaging probe (FLIP) for impedance planimetry of the UES in the diagnostic and peri-operative work-up. […] Flexible endoscopic approaches have been developed over the past few decades as safe and effective alternatives to surgery for ZD treatment. […] FESD has demonstrated high clinical efficacy, with CS rates ranging from 90% to 100% across multiple studies. […] The outcomes of Z-POEM have been evaluated in several studies and meta-analyses. […] Managing ZD with a short septum presents significant challenges for endoscopists.

• #2 Zenker Diverticulum – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499996/

  Barium swallow with videofluoroscopy is the radiographic methods used for staging. […] The prognosis for these patients is dependant on which surgical procedure was performed. […] Proper follow-up is imperative to minimizing post-operative complications and infections. […] An interprofessional approach to Zenker diverticulum is necessary as the diagnosis can be delayed because of the vague symptoms. […] Patients admitted with a diagnosis of Zenker diverticulum need to be looked after an interprofessional team of healthcare professionals because there are many treatment options. […] The key is to have an experienced surgeon or endoscopist.

• #2 Zenker’s Diverticulum | Tampa General Hospital 

  https://www.tgh.org/institutes-and-services/conditions/zenkers-diverticulum

  Proper diagnosis of a Zenkers diverticulum is essential for effective treatment. […] The primary diagnostic techniques include: […] Clinical evaluation A physician will assess the symptoms and perform a physical examination and medical history review. […] Barium swallow study As X-rays are continually captured, the patient will swallow a barium contrast solution, which will coat the esophagus and enhance the clarity of the images. This can help the physician visualize the diverticulum (if present) and assess its size and location. […] Upper endoscopy A physician will guide a flexible tube with a miniature camera attached to the end (endoscope) through the mouth and into the esophagus. Using the endoscope, the physician can gain a direct view of the Zenkers diverticulum (if present) and assess its severity.

• #2 Zenker’s Diverticulum | Southern California, Orange County, Otolaryngology ENT

  https://throatdisorder.com/zenkers-diverticulum/

  Zenkers Diverticulum: What is it and How do you Treat it? […] Diagnosis of Zenkers Diverticulum: […] Medical History: Focusing on issues such as weight loss, avoidance of eating, difficulty eating including regurgitation or aspiration of food. […] Physical Exam: Although a Zenkers Diverticulum can be 15cm or more, it is rarely felt on physical exam. Diagnosis is achieved through detailed history taking and imaging studies (discussed below). […] Imaging Studies: Although endoscopic evaluation is increasingly being used to diagnose esophageal diverticula, the barium swallow is still considered the most effective way to diagnose a Zenkers diverticulum. The patient is given a barium solution to drink, the solution fills the pouch in the esophageal wall, and it can be seen on an X-ray. This study provides information about the size, location, and character of the mucosal lining of the diverticulum.

• #2 Zenker’s Diverticulum | Southern California, Orange County, Otolaryngology ENT

  https://throatdisorder.com/zenkers-diverticulum/

  Treatment of Zenkers Diverticulum: […] Zenkers diverticula are normally not treated unless they cause symptoms. […] A Zenkers diverticulum which is causing symptoms is usually treated through surgical intervention. […] Non-Surgical Management of Zenkers Diverticulum: […] In patients with small diverticula (2cm) or those who are unable to physically endure a surgical procedure, non-surgical treatment options such as dilation and botulium toxin MAY be used to alleviate symptoms such as difficulty swallowing. […] Surgical Treatment of Zenkers Diverticulum: […] Due to the distress experienced by patients from symptoms of the diverticulum, as well as the risk of aspiration and pneumonia, surgical intervention is recommended for all patients with Zenkers Diverticulum that are physically able to undergo surgery.

• #2 What Is the Best Technique for Diagnosing Esophageal Diverticulum? – Page 5 of 5 – ENTtoday

  https://www.enttoday.org/article/what-is-the-best-technique-for-diagnosing-esophageal-diverticulum/5/?singlepage=1

  Dr. Postma prefers to prepare his patients before surgery regarding the approach he will take, and the barium swallow allows him to do this with 97% certainty, he said. […] If you see someone who has dysphagia and you’re not sure of the etiology based on FEES and TNE, then you can always obtain a barium esophagogram or a modified barium swallow study, he said. […] Dr. Chhetri estimated that in the past year, he diagnosed and treated approximately one patient per month with Zenkers. Its not an everyday thing, but it is a highly treatable condition.

• #3 Zenker’s diverticulum: aetiopathogenesis, symptoms and diagnosis. Comparison of operative methods

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4027817/

  Zenkers diverticulum manifests itself with characteristic symptoms and signs. The first and most common symptom is a gradually increasing dysphagia. In consequence of regurgitations the aspiration of ingesta into the bronchial tree may appear and subsequent dyspnea due to Mendelsons syndrome. Characteristic are loud swallowing of liquids, cough and hoarseness. Over time the diverticulum grows and patients complain of dysphagia due to esophagus constriction by the filled diverticulum. Voice alteration and halitosis may also occur. […] The diagnosis is based on a radiogram with barite that reveals a diverticulum filled with contrast on the side of the esophagus. Esophagogastroduodenoscopy may be useful in ZD and operation conditions assessment. Another valuable, but technically difficult examination is UES manometry. Manometry is not useful in the routine diagnostic approach due to, among others, catheter dislocation during examination impeding the proper analysis.

• #3 Zenker’s Diverticulum | Southern California, Orange County, Otolaryngology ENT

  https://throatdisorder.com/zenkers-diverticulum/

  Zenkers Diverticulum: What is it and How do you Treat it? […] Diagnosis of Zenkers Diverticulum: […] Medical History: Focusing on issues such as weight loss, avoidance of eating, difficulty eating including regurgitation or aspiration of food. […] Physical Exam: Although a Zenkers Diverticulum can be 15cm or more, it is rarely felt on physical exam. Diagnosis is achieved through detailed history taking and imaging studies (discussed below). […] Imaging Studies: Although endoscopic evaluation is increasingly being used to diagnose esophageal diverticula, the barium swallow is still considered the most effective way to diagnose a Zenkers diverticulum. The patient is given a barium solution to drink, the solution fills the pouch in the esophageal wall, and it can be seen on an X-ray. This study provides information about the size, location, and character of the mucosal lining of the diverticulum.

• #3 Zenker’s diverticulum – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/zenkers-diverticulum/symptoms-causes/syc-20568839

  Zenker’s diverticulum is diagnosed mainly by what’s called a swallow study. […] The upper part of the swallow is called a video fluoroscopic swallow study. […] The second part of the swell study is really important, though, and that’s called the esophagram, where they look at the esophagus, and that’s also called a barium swallow. […] The chance of recurrence after Zenker’s surgery really depends on the approach and the procedure and the surgeon who’s doing it. […] Overall, the recurrence rate for certain procedures such as the flexible approach, the endoscopic stapler approach and the harmonic scalpel approach are higher. […] The latest research shows around 15% or more than the typical laser approach we use here with a rigid laser or the open neck approach. Those have lower recurrence rates.

• #3 Zenker diverticulum | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/zenker-diverticulum-1?lang=us

  Zenker diverticulum, also known as a pharyngeal pouch, is a posterior outpouching of the hypopharynx, just proximal to the upper esophageal sphincter through a weakness in the muscle layer called the Killian dehiscence. […] Ideally, a barium swallow examination is performed, which may show: a diverticulum arising from the midline of the posterior wall of the distal pharynx near the pharyngoesophageal junction. […] The pouch is best identified during swallowing and is best seen on the lateral view, on which the diverticulum is typically noted at the C5-6 level. […] Since ~90% of patients with a Zenker diverticulum have a hiatal hernia and gastro-esophageal reflux, the distal esophagus should also be evaluated.

• #3 Zenker’s Diverticulum – Esophageal Health | UCLA Health

  https://www.uclahealth.org/medical-services/gastro/esophageal-health/diseases-we-treat/zenkers-diverticulum

  Zenker’s diverticulum is diagnosed during upper endoscopy (EGD) or esophagram (aka barium swallow), or a modified barium swallow study (aka videofluoroscopic swallow study) (see figure). These tests complementary during investigation of swallowing problems. […] The goal of treatment of Zenkers diverticulum is to relieve the obstruction to swallowing caused by the tight UES and eliminate the preferential passage and accumulation of swallowed material into the diverticulum. For a large or complicated diverticulum, open neck surgery may be necessary to remove the diverticulum sac (Zenkers diverticulectomy), but most patients with symptomatic Zenkers diverticulum are now treated in a minimally invasive endoscopic approach. Endoscopic cricopharyngeal myotomy (diverticulotomy) has become a primary and important means of treatment of Zenkers diverticulum. This procedure involves cutting the tight UES muscle and the party wall between the esophagus and the pouch to eliminate the obstruction. This procedure remodels the anatomy of the esophagus relative to the diverticulum so that swallowed material easily passes from the diverticulum into the esophagus.

• #3 Esophageal Diverticula Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/174402-workup

  Most laboratory studies are not helpful in the diagnosis. […] Radiographic studies and upper GI endoscopy detect many esophageal diverticula incidentally because esophageal diverticula often are asymptomatic. […] Barium swallow is a useful study in patients who are symptomatic and have mid esophageal and epiphrenic diverticula. Diagnosis of Zenker diverticulum is made best using barium swallow, which should include lateral views of the pharyngoesophageal junction. It also can be made using careful upper endoscopy by an experienced endoscopist. […] Endoscopy is unnecessary in a patient with Zenker diverticula if the diagnosis has been made using barium radiograph. If flexible upper GI endoscopy is needed in a patient with a known Zenker diverticulum, it should be performed with caution, with the endoscope being passed under direct visualization to minimize the risk of perforation.

• #3 Zenker’s Diverticulum: Symptoms and Treatment

  https://www.webmd.com/digestive-disorders/what-is-zenkers-diverticulum

  If your doctor thinks that you might have Zenkers diverticulum, they will most likely order a test called an esophagram, or barium swallow. A contrast, barium, is used to fill the pouch so that your doctor can see it in pictures. This test helps your doctor better understand what is causing your difficulty when swallowing. […] Another test for diagnosing Zenkers diverticulum is an upper endoscopy. An endoscopy gives your doctor a look at the pouch and how big it is. […] The last possibility when it comes to diagnosing Zenkers diverticulum is esophageal manometry. This is a test that studies the pressure inside of your esophagus.

• #4 Zenker Diverticulum: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/836858-overview

  Special maneuvers to dislodge food. […] Coughing after eating. […] Aspiration of organic material. […] Unexplained weight loss. […] Fetor ex ore (halitosis). […] Borborygmi in the neck. […] Symptoms may last from months to years. […] The most common life-threatening complication in patients with a Zenker diverticulum is aspiration. […] Other complications include massive bleeding from the mucosa or from fistulization into a major vessel, esophageal obstruction, and fistulization into the trachea. […] Squamous cell carcinoma (SCC) within a Zenker diverticulum is extremely rare, occurring in 0.3% of Zenker diverticula worldwide. […] A Mayo Clinic review suggests an incidence of 0.48% in the United States. […] The criterion standard for confirmatory evaluations is the barium swallow with videofluoroscopy.

• #5 Zenker’s diverticulum: aetiopathogenesis, symptoms and diagnosis. Comparison of operative methods

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4027817/

  Zenkers diverticulum manifests itself with characteristic symptoms and signs. The first and most common symptom is a gradually increasing dysphagia. In consequence of regurgitations the aspiration of ingesta into the bronchial tree may appear and subsequent dyspnea due to Mendelsons syndrome. Characteristic are loud swallowing of liquids, cough and hoarseness. Over time the diverticulum grows and patients complain of dysphagia due to esophagus constriction by the filled diverticulum. Voice alteration and halitosis may also occur. […] The diagnosis is based on a radiogram with barite that reveals a diverticulum filled with contrast on the side of the esophagus. Esophagogastroduodenoscopy may be useful in ZD and operation conditions assessment. Another valuable, but technically difficult examination is UES manometry. Manometry is not useful in the routine diagnostic approach due to, among others, catheter dislocation during examination impeding the proper analysis.

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