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Esophagopharyngeal Diverticulum (Zenker)
Luke N. Ledbetter, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Synonyms

              • Pharyngeal pouch, pharyngoesophageal diverticulum, posterior hypopharyngeal diverticulum
            • Definitions

              • Mucosa-lined outpouching of posterior hypopharynx
              • Posterior pulsion diverticulum above cricopharyngeus

            IMAGING

            • General Features

              • Fluoroscopic Findings

                • CT Findings

                  • MR Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Mantsopoulos K et al: Clinical relevance and prognostic value of radiographic findings in Zenker's diverticulum. Eur Arch Otorhinolaryngol. 271(3):583-8, 2014
                                            2. Prisman E et al: Zenker diverticulum. Otolaryngol Clin North Am. 46(6):1101-11, 2013
                                            3. Dale OT et al: Pharyngeal pouch surgery: a combined open and endoscopic approach. Laryngoscope. 122(4):810-2, 2012
                                            4. Ongkasuwan J et al: Pharyngeal stasis of secretions in patients with Zenker diverticulum. Otolaryngol Head Neck Surg. 146(3):426-9, 2012
                                            5. Grant PD et al: Pharyngeal dysphagia: what the radiologist needs to know. Curr Probl Diagn Radiol. 38(1):17-32, 2009
                                            6. Ferreira LE et al: Zenker's diverticula: pathophysiology, clinical presentation, and flexible endoscopic management. Dis Esophagus. 21(1):1-8, 2008
                                            7. Aly A et al: Evolution of surgical treatment for pharyngeal pouch. Br J Surg. 91(6):657-64, 2004
                                            8. Sen P et al: Endoscopic stapling of pharyngeal pouch. J Laryngol Otol. 118(8):601-6, 2004
                                            9. Chang CY et al: Endoscopic staple diverticulostomy for Zenker's diverticulum: review of literature and experience in 159 consecutive cases. Laryngoscope. 113(6):957-65, 2003
                                            10. Colombo-Benkmann M et al: Cricopharyngeal myotomy in the treatment of Zenker's diverticulum. J Am Coll Surg. 196(3):370-7; discussion 377; author reply 378, 2003
                                            11. Hoffmann M et al: Zenker's diverticulotomy with the carbon dioxide laser: perioperative management and long-term results. Ann Otol Rhinol Laryngol. 112(3):202-5, 2003
                                            12. Maune S: Carbon dioxide laser diverticulostomy: a new treatment for Zenker diverticulum. Am J Med. 115 Suppl 3A:172S-174S, 2003
                                            13. Richtsmeier WJ: Endoscopic management of Zenker diverticulum: the staple-assisted approach. Am J Med. 115 Suppl 3A:175S-178S, 2003
                                            14. Sasaki CT et al: Association between Zenker diverticulum and gastroesophageal reflux disease: development of a working hypothesis. Am J Med. 115 Suppl 3A:169S-171S, 2003
                                            15. Scher RL: Endoscopic staple diverticulostomy for recurrent Zenker's diverticulum. Laryngoscope. 113(1):63-7, 2003
                                            16. van Overbeek JJ: Pathogenesis and methods of treatment of Zenker's diverticulum. Ann Otol Rhinol Laryngol. 112(7):583-93, 2003
                                            17. Veenker EA et al: Cricopharyngeal spasm and Zenker's diverticulum. Head Neck. 25(8):681-94, 2003
                                            18. Zaninotto G et al: Tailored approach to Zenker's diverticula. Surg Endosc. 17(1):129-33, 2003
                                            19. Gutschow CA et al: Management of pharyngoesophageal (Zenker's) diverticulum: which technique? Ann Thorac Surg. 74(5):1677-82; discussion 1682-3, 2002
                                            20. Krespi Y et al: Endoscopic treatment of Zenker's diverticulum using CO2 laser. Otolaryngol Head Neck Surg. 127(4):309-14, 2002
                                            21. Mirza S et al: A retrospective review of pharyngeal pouch surgery in 56 patients. Ann R Coll Surg Engl. 84(4):247-51, 2002
                                            22. Raut VV et al: Long-term results of endoscopic stapling diverticulotomy for pharyngeal pouches. Otolaryngol Head Neck Surg. 127(3):225-9, 2002
                                            23. Siddiq MA et al: Pharyngeal pouch (Zenker's diverticulum). Postgrad Med J. 77(910):506-11, 2001
                                            24. Sydow BD et al: Radiographic findings and complications after surgical or endoscopic repair of Zenker's diverticulum in 16 patients. AJR Am J Roentgenol. 177(5):1067-71, 2001
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      TERMINOLOGY

                                                      • Synonyms

                                                        • Pharyngeal pouch, pharyngoesophageal diverticulum, posterior hypopharyngeal diverticulum
                                                      • Definitions

                                                        • Mucosa-lined outpouching of posterior hypopharynx
                                                        • Posterior pulsion diverticulum above cricopharyngeus

                                                      IMAGING

                                                      • General Features

                                                        • Fluoroscopic Findings

                                                          • CT Findings

                                                            • MR Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Staging, Grading, & Classification

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Mantsopoulos K et al: Clinical relevance and prognostic value of radiographic findings in Zenker's diverticulum. Eur Arch Otorhinolaryngol. 271(3):583-8, 2014
                                                                                      2. Prisman E et al: Zenker diverticulum. Otolaryngol Clin North Am. 46(6):1101-11, 2013
                                                                                      3. Dale OT et al: Pharyngeal pouch surgery: a combined open and endoscopic approach. Laryngoscope. 122(4):810-2, 2012
                                                                                      4. Ongkasuwan J et al: Pharyngeal stasis of secretions in patients with Zenker diverticulum. Otolaryngol Head Neck Surg. 146(3):426-9, 2012
                                                                                      5. Grant PD et al: Pharyngeal dysphagia: what the radiologist needs to know. Curr Probl Diagn Radiol. 38(1):17-32, 2009
                                                                                      6. Ferreira LE et al: Zenker's diverticula: pathophysiology, clinical presentation, and flexible endoscopic management. Dis Esophagus. 21(1):1-8, 2008
                                                                                      7. Aly A et al: Evolution of surgical treatment for pharyngeal pouch. Br J Surg. 91(6):657-64, 2004
                                                                                      8. Sen P et al: Endoscopic stapling of pharyngeal pouch. J Laryngol Otol. 118(8):601-6, 2004
                                                                                      9. Chang CY et al: Endoscopic staple diverticulostomy for Zenker's diverticulum: review of literature and experience in 159 consecutive cases. Laryngoscope. 113(6):957-65, 2003
                                                                                      10. Colombo-Benkmann M et al: Cricopharyngeal myotomy in the treatment of Zenker's diverticulum. J Am Coll Surg. 196(3):370-7; discussion 377; author reply 378, 2003
                                                                                      11. Hoffmann M et al: Zenker's diverticulotomy with the carbon dioxide laser: perioperative management and long-term results. Ann Otol Rhinol Laryngol. 112(3):202-5, 2003
                                                                                      12. Maune S: Carbon dioxide laser diverticulostomy: a new treatment for Zenker diverticulum. Am J Med. 115 Suppl 3A:172S-174S, 2003
                                                                                      13. Richtsmeier WJ: Endoscopic management of Zenker diverticulum: the staple-assisted approach. Am J Med. 115 Suppl 3A:175S-178S, 2003
                                                                                      14. Sasaki CT et al: Association between Zenker diverticulum and gastroesophageal reflux disease: development of a working hypothesis. Am J Med. 115 Suppl 3A:169S-171S, 2003
                                                                                      15. Scher RL: Endoscopic staple diverticulostomy for recurrent Zenker's diverticulum. Laryngoscope. 113(1):63-7, 2003
                                                                                      16. van Overbeek JJ: Pathogenesis and methods of treatment of Zenker's diverticulum. Ann Otol Rhinol Laryngol. 112(7):583-93, 2003
                                                                                      17. Veenker EA et al: Cricopharyngeal spasm and Zenker's diverticulum. Head Neck. 25(8):681-94, 2003
                                                                                      18. Zaninotto G et al: Tailored approach to Zenker's diverticula. Surg Endosc. 17(1):129-33, 2003
                                                                                      19. Gutschow CA et al: Management of pharyngoesophageal (Zenker's) diverticulum: which technique? Ann Thorac Surg. 74(5):1677-82; discussion 1682-3, 2002
                                                                                      20. Krespi Y et al: Endoscopic treatment of Zenker's diverticulum using CO2 laser. Otolaryngol Head Neck Surg. 127(4):309-14, 2002
                                                                                      21. Mirza S et al: A retrospective review of pharyngeal pouch surgery in 56 patients. Ann R Coll Surg Engl. 84(4):247-51, 2002
                                                                                      22. Raut VV et al: Long-term results of endoscopic stapling diverticulotomy for pharyngeal pouches. Otolaryngol Head Neck Surg. 127(3):225-9, 2002
                                                                                      23. Siddiq MA et al: Pharyngeal pouch (Zenker's diverticulum). Postgrad Med J. 77(910):506-11, 2001
                                                                                      24. Sydow BD et al: Radiographic findings and complications after surgical or endoscopic repair of Zenker's diverticulum in 16 patients. AJR Am J Roentgenol. 177(5):1067-71, 2001