Diagnosis
Esophageal diverticula
Outpouching of the esophageal mucosa.
Also known as: Killian-Jamieson diverticula, Rokitansky diverticula, Zenker’s diverticulum
Etiology
Cause/Pathophysiology [so2][5v1]
Esophageal dysmotility (achalasia) --> intraluminal pressure increase --> herniation
Secondary to mediastinal inflammatory processes --> weakness of the wall
Zenker diverticulum occurs in between the muscle fibers where there is a weakness.
Anatomical localisation [so2]
Cervical: Zenker, Killian-Jamieson
Thoracic: Rokitansky
Epiphrenic
True diverticulum involves all three layers of the esophagus
A false diverticulum involves only the mucosa and submucosa
Complications [5v1]
Esophageal obstruction
Perforation
Squamous cell carcinoma
Epidemiology
Incidence per 100.000 [kuc][so2][uk5]
Symptoms & findings
Symptoms
Anorexia, Cachexia, Choking, Dysphagia, Globus sensation, Halitosis, Regurgitation, Weakness, Weight loss
Clinical findings
Anamneses
None listed.
Localized findings
Approach
Barium enema
Gastroscopy
Treatment
Asymptomatic patient: wait and see
Symptomatic patient:
Endoscopic diverticulectomy and myotomy (Dohlman Procedure)
Surgery (open/thoracoscopic)
Diverticulectomy, diverticulopexy, diverticular inversion w/wo myotomy
Differential diagnoses
Achalasia, Esophageal cancer, Esophageal perforation, Esophageal spasm, Esophageal stricture, Gastroesophageal reflux disease
References
[1] Constantin A, Constantinoiu S, Achim F, Socea B, Costea DO, Predescu D. Esophageal diverticula: from diagnosis to therapeutic management-narrative review. J Thorac Dis. 2023 Feb 28;15(2):759-779.
[2] Yam J, Baldwin DL, Ahmad SA. Esophageal Diverticula. [Updated 2023 Apr 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532858/
[3] Leong SC, Wilkie MD, Webb CJ. Endoscopic stapling of Zenker's diverticulum: establishing national baselines for auditing clinical outcomes in the United Kingdom. Eur Arch Otorhinolaryngol. 2012 Aug;269(8):1877-84.
[4] Surgical Management of Mid- and Distal Esophageal Diverticula. Brian E. Louie, Oliver C. Bellevue, in Shackelford's Surgery of the Alimentary Tract, 2 Volume Set (Eighth Edition), 2019
[5] Sato H, Takeuchi M, Hashimoto S, Mizuno KI, Furukawa K, Sato A, Yokoyama J, Terai S. Esophageal diverticulum: New perspectives in the era of minimally invasive endoscopic treatment. World J Gastroenterol. 2019 Mar 28;25(12):1457-1464.