Skip to main content

Esophageal Diverticula

  • Chapter
  • First Online:
Benign Esophageal Disease

Abstract

Esophageal diverticula are outpouchings of the esophageal mucosa and submucosa and are found throughout the esophagus. Esophageal diverticula classified by location and are divided into traction and pulsion mechanisms. Most types of esophageal diverticula are more common beyond the sixth decade of life and may be diagnosed by endoscopy and/or fluorometric studies. Treatment is largely focused on symptoms, though size alone may be an indication to seek treatment. Treatment approaches differ based on anatomic location of the diverticulum. The best accumulated evidence is for treatment of hypopharyngeal diverticula, more commonly known by their eponymous designation: Zenker’s diverticula. Treatment may be surgical, via direct endoscopy for flexible endoscopic approaches, including tunneled submucosal approaches.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Law R, Katzka DA, Baron TH. Zenker’s Diverticulum. Clin Gastroenterol Hepatol. 2014;12:1773–82; quiz e111-112.

    Article  PubMed  Google Scholar 

  2. Ferreira LEVVC, Simmons DT, Baron TH. Zenker’s diverticula: pathophysiology, clinical presentation, and flexible endoscopic management. Dis Esophagus. 2008;21:1–8.

    Article  CAS  PubMed  Google Scholar 

  3. Laing MR, Murthy P, Ah-See KW, Cockburn JS. Surgery for pharyngeal pouch: audit of management with short- and long-term follow-up. J R Coll Surg Edinb. 1995;40:315–8.

    CAS  PubMed  Google Scholar 

  4. van Overbeek JJ. Meditation on the pathogenesis of hypopharyngeal (Zenker’s) diverticulum and a report of endoscopic treatment in 545 patients. Ann Otol Rhinol Laryngol. 1994;103:178–85.

    Article  PubMed  Google Scholar 

  5. Rice TW, Baker ME. Midthoracic esophageal diverticula. Semin Thorac Cardiovasc Surg. 1999;11:352–7.

    Article  CAS  PubMed  Google Scholar 

  6. Allen MS. Treatment of epiphrenic diverticula. Semin Thorac Cardiovasc Surg. 1999;11:358–62.

    Article  CAS  PubMed  Google Scholar 

  7. Scher RL, Puscas L. Chapter 71: Zenker diverticulum. In: Cummings Otolaryngology. 6th ed. Philadelphia: Saunders Elsevier; 2015. p. 1025–34.

    Google Scholar 

  8. Zaninotto G, Costantini M. Chapter 11: Cricopharyngeal dysfunction and Zenker diverticulum. In: Shackelfords surgery alimentary tract. 8th ed. Philadelphia: Elsevier; 2019. p. 157–72.

    Chapter  Google Scholar 

  9. Cook IJ, Gabb M, Panagopoulos V, Jamieson GG, Dodds WJ, Dent J, Shearman DJ. Pharyngeal (Zenker’s) diverticulum is a disorder of upper esophageal sphincter opening. Gastroenterology. 1992;103:1229–35.

    Article  CAS  PubMed  Google Scholar 

  10. Veenker EA, Andersen PE, Cohen JI. Cricopharyngeal spasm and Zenker’s diverticulum. Head Neck. 2003;25:681–94.

    Article  PubMed  Google Scholar 

  11. Zainabadi K, Courcoulas AP, Awais O, Raftopoulos I. Laparoscopic revision of Nissen fundoplication to Roux-en-Y gastric bypass in morbidly obese patients. Surg Endosc. 2008;22:2737–40.

    Article  PubMed  Google Scholar 

  12. Hillel AT, Flint PW. Evolution of endoscopic surgical therapy for Zenker’s diverticulum. Laryngoscope. 2009;119:39–44.

    Article  PubMed  Google Scholar 

  13. Regan J, Walshe M, Timon C, McMahon BP. Endoflip® evaluation of pharyngo-oesophageal segment tone and swallowing in a clinical population: a total laryngectomy case series. Clin Otolaryngol. 2015;40:121–9.

    Article  CAS  PubMed  Google Scholar 

  14. Regan J, Walshe M, Rommel N, Tack J, McMahon BP. New measures of upper esophageal sphincter distensibility and opening patterns during swallowing in healthy subjects using EndoFLIP®. Neurogastroenterol Motil. 2013;25:e25–34.

    Article  CAS  PubMed  Google Scholar 

  15. Pomerri F, Costantini M, Dal Bosco C, Battaglia G, Bottin R, Zanatta L, Ancona E, Muzzio PC. Comparison of preoperative and surgical measurements of Zenker’s diverticulum. Surg Endosc. 2012;26:2010–5.

    Article  PubMed  Google Scholar 

  16. Aly A, Devitt PG, Jamieson GG. Evolution of surgical treatment for pharyngeal pouch. Br J Surg. 2004;91:657–64.

    Article  CAS  PubMed  Google Scholar 

  17. Stewart K, Sen P. Pharyngeal pouch management: an historical review. J Laryngol Otol. 2016;130:116–20.

    Article  CAS  PubMed  Google Scholar 

  18. Lahey FH. Pharyngo-esophageal diverticulum: its management and complications. Ann Surg. 1946;124:617–36.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Sweet RH. Pulsion diverticulum of the pharyngo-esophageal junction: technic of the one-stage operation: a preliminary report. Ann Surg. 1947;125:41–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Sweet RH. Excision of diverticulum of the pharyngo-esophageal junction and lower esophagus by means of the one stage procedure; a subsequent report. Ann Surg. 1956;143:433–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Payne WS. The treatment of pharyngoesophageal diverticulum: the simple and complex. Hepato-Gastroenterology. 1992;39:109–14.

    CAS  PubMed  Google Scholar 

  22. Harrison MS. The aetiology, diagnosis and surgical treatment of pharyngeal diverticula. J Laryngol Otol. 1958;72:523–34.

    Article  CAS  PubMed  Google Scholar 

  23. Sutherland HD. Cricopharyngeal achalasia. J Thorac Cardiovasc Surg. 1962;43:114–26.

    Article  CAS  PubMed  Google Scholar 

  24. Belsey R. Functional disease of the esophagus. J Thorac Cardiovasc Surg. 1966;52:164–88.

    Article  CAS  PubMed  Google Scholar 

  25. Lerut T, van Raemdonck D, Guelinckx P, Dom R, Geboes K. Zenker’s diverticulum: is a myotomy of the cricopharyngeus useful? How long should it be? Hepato-Gastroenterology. 1992;39:127–31.

    CAS  PubMed  Google Scholar 

  26. Pera M, Yamada A, Hiebert CA, Duranceau A. Sleeve recording of upper esophageal sphincter resting pressures during cricopharyngeal myotomy. Ann Surg. 1997;225:229–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Mosher H. Webs and pouches of the oesophagus, their diagnosis and tratment. Surg Gynecol Obstet. 1917;25:175.

    Google Scholar 

  28. Gaub O, Jackson C. Pulsion diverticulum of the esophagus: a new operatoin for its cure. Surg Gynecol Obstet. 1915;21:52.

    Google Scholar 

  29. Jackson C, Shallow TA. Diverticula of the oesophagus, pulsion, traction, malignant and congenital. Ann Surg. 1926;83:1–19.

    CAS  PubMed  PubMed Central  Google Scholar 

  30. Dohlman G, Mattsson O. The endoscopic operation for hypopharyngeal diverticula: a roentgencinematographic study. AMA Arch Otolaryngol. 1960;71:744–52.

    Article  CAS  PubMed  Google Scholar 

  31. Von Doersten PG, Byl FM. Endoscopic Zenker’s diverticulotomy (Dohlman procedure): forty cases reviewed. Otolaryngol Head Neck Surg. 1997;116:209–12.

    Google Scholar 

  32. Wayman DM, Byl FM, Adour KK. Endoscopic diverticulotomy for the treatment of Zenker’s diverticulum. Otolaryngol Head Neck Surg. 1991;104:448–52.

    Article  CAS  PubMed  Google Scholar 

  33. Lippert BM, Folz BJ, Rudert HH, Werner JA. Management of Zenker’s diverticulum and postlaryngectomy pseudodiverticulum with the CO2 laser. Otolaryngol Head Neck Surg. 1999;121:809–14.

    Article  CAS  PubMed  Google Scholar 

  34. Lippert BM, Folz BJ, Gottschlich S, Werner JA. Microendoscopic treatment of the hypopharyngeal diverticulum with the CO2 laser. Lasers Surg Med. 1997;20:394–401.

    Article  CAS  PubMed  Google Scholar 

  35. Kuhn FA, Bent JP. Zenker’s diverticulotomy using the KTP/532 laser. Laryngoscope. 1992;102:946–50.

    Article  CAS  PubMed  Google Scholar 

  36. Collard JM, Otte JB, Kestens PJ. Endoscopic stapling technique of esophagodiverticulostomy for Zenker’s diverticulum. Ann Thorac Surg. 1993;56:573–6.

    Article  CAS  PubMed  Google Scholar 

  37. Scher RL, Richtsmeier WJ. Long-term experience with endoscopic staple-assisted esophagodiverticulostomy for Zenker’s diverticulum. Laryngoscope. 1998;108:200–5.

    Article  CAS  PubMed  Google Scholar 

  38. Thaler ER, Weber RS, Goldberg AN, Weinstein GS. Feasibility and outcome of endoscopic staple-assisted esophagodiverticulostomy for Zenker’s diverticulum. Laryngoscope. 2001;111:1506–8.

    Article  CAS  PubMed  Google Scholar 

  39. Cook RD, Huang PC, Richstmeier WJ, Scher RL. Endoscopic staple-assisted esophagodiverticulostomy: an excellent treatment of choice for Zenker’s diverticulum. Laryngoscope. 2000;110:2020–5.

    Article  CAS  PubMed  Google Scholar 

  40. Lüscher MS, Johansen LV. Zenker’s diverticulum treated by the endoscopic stapling technique. Acta Otolaryngol Suppl. 2000;543:235–8.

    PubMed  Google Scholar 

  41. Baldwin DL, Toma AG. Endoscopic stapled diverticulotomy: a real advance in the treatment of hypopharyngeal diverticulum. Clin Otolaryngol Allied Sci. 1998;23:244–7.

    Article  CAS  PubMed  Google Scholar 

  42. Philippsen LP, Weisberger EC, Whiteman TS, Schmidt JL. Endoscopic stapled diverticulotomy: treatment of choice for Zenker’s diverticulum. Laryngoscope. 2000;110:1283–6.

    Article  CAS  PubMed  Google Scholar 

  43. Narne S, Cutrone C, Bonavina L, Chella B, Peracchia A. Endoscopic diverticulotomy for the treatment of Zenker’s diverticulum: results in 102 patients with staple-assisted endoscopy. Ann Otol Rhinol Laryngol. 1999;108:810–5.

    Article  CAS  PubMed  Google Scholar 

  44. Omote K, Feussner H, Stein HJ, Ungeheuer A, Siewert JR. Endoscopic stapling diverticulostomy for Zenker’s diverticulum. Surg Endosc. 1999;13:535–8.

    Article  CAS  PubMed  Google Scholar 

  45. Koay CB, Bates GJ. Endoscopic stapling diverticulotomy for pharyngeal pouch. Clin Otolaryngol Allied Sci. 1996;21:371–6.

    Article  CAS  PubMed  Google Scholar 

  46. Peracchia A, Bonavina L, Narne S, Segalin A, Antoniazzi L, Marotta G. Minimally invasive surgery for Zenker diverticulum: analysis of results in 95 consecutive patients. Arch Surg. 1998;133:695–700.

    Article  CAS  PubMed  Google Scholar 

  47. Raut VV, Primrose WJ. Long-term results of endoscopic stapling diverticulotomy for pharyngeal pouches. Otolaryngol Head Neck Surg. 2002;127:225–9.

    Article  PubMed  Google Scholar 

  48. Stoeckli SJ, Schmid S. Endoscopic stapler-assisted diverticuloesophagostomy for Zenker’s diverticulum: patient satisfaction and subjective relief of symptoms. Surgery. 2002;131:158–62.

    Article  PubMed  Google Scholar 

  49. Bonavina L, Aiolfi A, Scolari F, Bona D, Lovece A, Asti E. Long-term outcome and quality of life after transoral stapling for Zenker diverticulum. World J Gastroenterol. 2015;21:1167–72.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Wasserzug O, Zikk D, Raziel A, Cavel O, Fleece D, Szold A. Endoscopically stapled diverticulostomy for Zenker’s diverticulum: results of a multidisciplinary team approach. Surg Endosc. 2010;24:637–41.

    Article  PubMed  Google Scholar 

  51. Jaramillo MJ, McLay KA, McAteer D. Long-term clinico-radiological assessment of endoscopic stapling of pharyngeal pouch: a series of cases. J Laryngol Otol. 2001;115:462–6.

    Article  CAS  PubMed  Google Scholar 

  52. Morse CR, Fernando HC, Ferson PF, Landreneau RJ, Luketich JD. Preliminary experience by a thoracic service with endoscopic transoral stapling of cervical (Zenker’s) diverticulum. J Gastrointest Surg. 2007;11:1091–4.

    Article  PubMed  Google Scholar 

  53. 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;269:1877–84.

    Article  PubMed  Google Scholar 

  54. Koay CB, Commins D, Bates GJ. The role of endoscopic stapling diverticulotomy in recurrent pharyngeal pouch. J Laryngol Otol. 1998;112:954–5.

    Article  CAS  PubMed  Google Scholar 

  55. Verdonck J, Morton RP. Systematic review on treatment of Zenker’s diverticulum. Eur Arch Otorhinolaryngol. 2015;272:3095–107.

    Article  PubMed  Google Scholar 

  56. Sakai P. Endoscopic myotomy of Zenker’s diverticulum: lessons from 3 decades of experience. Gastrointest Endosc. 2016;83:774–5.

    Article  PubMed  Google Scholar 

  57. Ishioka S, Sakai P, Maluf Filho F, Melo JM. Endoscopic incision of Zenker’s diverticula. Endoscopy. 1995;27:433–7.

    Article  CAS  PubMed  Google Scholar 

  58. Mulder CJ, den Hartog G, Robijn RJ, Thies JE. Flexible endoscopic treatment of Zenker’s diverticulum: a new approach. Endoscopy. 1995;27:438–42.

    Article  CAS  PubMed  Google Scholar 

  59. Mulder CJ. Zapping Zenker’s diverticulum: gastroscopic treatment. Can J Gastroenterol. 1999;13:405–7.

    Article  CAS  PubMed  Google Scholar 

  60. Rabenstein T, May A, Michel J, Manner H, Pech O, Gossner L, Ell C. Argon plasma coagulation for flexible endoscopic Zenker’s diverticulotomy. Endoscopy. 2007;39:141–5.

    Article  CAS  PubMed  Google Scholar 

  61. Repici A, Pagano N, Romeo F, Danese S, Arosio M, Rando G, Strangio G, Carlino A, Malesci A. Endoscopic flexible treatment of Zenker’s diverticulum: a modification of the needle-knife technique. Endoscopy. 2010;42:532–5.

    Article  CAS  PubMed  Google Scholar 

  62. Rouquette O, Abergel A, Mulliez A, Poincloux L. Usefulness of the Hook knife in flexible endoscopic myotomy for Zenker’s diverticulum. World J Gastrointest Endosc. 2017;9:411–6.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Laquière A, Grandval P, Arpurt JP, Boulant J, Belon S, Aboukheir S, Laugier R, Penaranda G, Curel L, Boustière C. Interest of submucosal dissection knife for endoscopic treatment of Zenker’s diverticulum. Surg Endosc. 2015;29:2802–10.

    Article  PubMed  Google Scholar 

  64. Manno M, Manta R, Caruso A, Bertani H, Mirante VG, Osja E, Bassotti G, Conigliaro R. Alternative endoscopic treatment of Zenker’s diverticulum: a case series (with video). Gastrointest Endosc. 2014;79:168–70.

    Article  PubMed  Google Scholar 

  65. Battaglia G, Antonello A, Realdon S, Cesarotto M, Zanatta L, Ishaq S. Flexible endoscopic treatment for Zenker’s diverticulum with the SB Knife. Preliminary results from a single-center experience. Dig Endosc. 2015;27:728–33.

    Article  PubMed  Google Scholar 

  66. Antonello A, Ishaq S, Zanatta L, Cesarotto M, Costantini M, Battaglia G. The role of flexible endotherapy for the treatment of recurrent Zenker’s diverticula after surgery and endoscopic stapling. Surg Endosc. 2016;30:2351–7.

    Article  PubMed  Google Scholar 

  67. Costamagna G, Iacopini F, Tringali A, Marchese M, Spada C, Familiari P, Mutignani M, Bella A. Flexible endoscopic Zenker’s diverticulotomy: cap-assisted technique vs. diverticuloscope-assisted technique. Endoscopy. 2007;39:146–52.

    Article  CAS  PubMed  Google Scholar 

  68. Vogelsang A, Preiss C, Neuhaus H, Schumacher B. Endotherapy of Zenker’s diverticulum using the needle-knife technique: long-term follow-up. Endoscopy. 2007;39:131–6.

    Article  CAS  PubMed  Google Scholar 

  69. Huberty V, El Bacha S, Blero D, Le Moine O, Hassid S, Devière J. Endoscopic treatment for Zenker’s diverticulum: long-term results (with video). Gastrointest Endosc. 2013;77:701–7.

    Article  PubMed  Google Scholar 

  70. Costamagna G, Iacopini F, Bizzotto A, Familiari P, Tringali A, Perri V, Bella A. Prognostic variables for the clinical success of flexible endoscopic septotomy of Zenker’s diverticulum. Gastrointest Endosc. 2016;83:765–73.

    Article  PubMed  Google Scholar 

  71. Katzka DA, Baron TH. Transoral flexible endoscopic therapy of Zenker’s diverticulum: is it time for gastroenterologists to stick their necks out? Gastrointest Endosc. 2013;77:708–10.

    Article  PubMed  Google Scholar 

  72. Hashiba K, de Paula AL, da Silva JG, Cappellanes CA, Moribe D, Castillo CF, Brasil HA. Endoscopic treatment of Zenker’s diverticulum. Gastrointest Endosc. 1999;49:93–7.

    Article  CAS  PubMed  Google Scholar 

  73. Sakai P, Ishioka S, Maluf-Filho F, Chaves D, Moura EG. Endoscopic treatment of Zenker’s diverticulum with an oblique-end hood attached to the endoscope. Gastrointest Endosc. 2001;54:760–3.

    Article  CAS  PubMed  Google Scholar 

  74. Christiaens P, De Roock W, Van Olmen A, Moons V, D’Haens G. Treatment of Zenker’s diverticulum through a flexible endoscope with a transparent oblique-end hood attached to the tip and a monopolar forceps. Endoscopy. 2007;39:137–40.

    Article  CAS  PubMed  Google Scholar 

  75. Evrard S, Le Moine O, Hassid S, Devière J. Zenker’s diverticulum: a new endoscopic treatment with a soft diverticuloscope. Gastrointest Endosc. 2003;58:116–20.

    Article  PubMed  Google Scholar 

  76. Al-Kadi AS, Maghrabi AA, Thomson D, Gillman LM, Dhalla S. Endoscopic treatment of Zenker diverticulum: results of a 7-year experience. J Am Coll Surg. 2010;211:239–43.

    Article  PubMed  Google Scholar 

  77. Case DJ, Baron TH. Flexible endoscopic management of Zenker diverticulum: the Mayo Clinic experience. Mayo Clin Proc. 2010;85:719–22.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Halland M, Grooteman KV, Baron TH. Flexible endoscopic management of Zenker’s diverticulum: characteristics and outcomes of 52 cases at a tertiary referral center. Dis Esophagus. 2016;29:273–7.

    Article  CAS  PubMed  Google Scholar 

  79. Pescarus R, Shlomovitz E, Sharata AM, Cassera MA, Reavis KM, Dunst CM, Swanström LL. Trans-oral cricomyotomy using a flexible endoscope: technique and clinical outcomes. Surg Endosc. 2016;30:1784–9.

    Article  PubMed  Google Scholar 

  80. Perbtani Y, Suarez A, Wagh MS. Techniques and efficacy of flexible endoscopic therapy of Zenker’s diverticulum. World J Gastrointest Endosc. 2015;7:206–12.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Ishaq S, Hassan C, Antonello A, et al. Flexible endoscopic treatment for Zenker’s diverticulum: a systematic review and meta-analysis. Gastrointest Endosc. 2016;83:1076–1089.e5.

    Article  PubMed  Google Scholar 

  82. Gölder SK, Brueckner J, Ebigbo A, Messmann H. Double incision and snare resection in symptomatic Zenker’s diverticulum: a modification of the stag beetle knife technique. Endoscopy. 2018;50:137–41.

    Article  PubMed  Google Scholar 

  83. Pang M, Koop A, Brahmbhatt B, Bartel MJ, Woodward TA. Comparison of flexible endoscopic cricopharyngeal myectomy and myotomy approaches for Zenker diverticulum repair. Gastrointest Endosc. 2019;89:880–6.

    Article  PubMed  Google Scholar 

  84. Ishaq S, Sultan H, Siau K, Kuwai T, Mulder CJ, Neumann H. New and emerging techniques for endoscopic treatment of Zenker’s diverticulum: State-of-the-art review. Dig Endosc. 2018;30:449–60.

    Article  PubMed  Google Scholar 

  85. Beard K, Swanström LL. Zenker’s diverticulum: flexible versus rigid repair. J Thorac Dis. 2017;9:S154–62.

    Article  PubMed  PubMed Central  Google Scholar 

  86. Yang J, Zeng X, Yuan X, et al. An international study on the use of peroral endoscopic myotomy (POEM) in the management of esophageal diverticula: the first multicenter D-POEM experience. Endoscopy. 2019;51:346–9.

    Article  PubMed  Google Scholar 

  87. Li Q-L, Chen W-F, Zhang X-C, Cai M-Y, Zhang Y-Q, Hu J-W, He M-J, Yao L-Q, Zhou P-H, Xu M-D. Submucosal tunneling endoscopic septum division: a novel technique for treating Zenker’s diverticulum. Gastroenterology. 2016;151:1071–4.

    Article  PubMed  Google Scholar 

  88. Brieau B, Leblanc S, Bordacahar B, Barret M, Coriat R, Prat F, Chaussade S. Submucosal tunneling endoscopic septum division for Zenker’s diverticulum: a reproducible procedure for endoscopists who perform peroral endoscopic myotomy. Endoscopy. 2017;49:613–4.

    Article  PubMed  Google Scholar 

  89. Hernández Mondragón OV, Solórzano Pineda MO, Blancas Valencia JM. Zenker’s diverticulum: submucosal tunneling endoscopic septum division (Z-POEM). Dig Endosc. 2018;30:124.

    Article  PubMed  Google Scholar 

  90. Chang CY, Payyapilli RJ, Scher RL. Endoscopic staple diverticulostomy for Zenker’s diverticulum: review of literature and experience in 159 consecutive cases. Laryngoscope. 2003;113:957–65.

    Article  PubMed  Google Scholar 

  91. Palanivelu C, Rangarajan M, Senthilkumar R, Velusamy M. Combined thoracoscopic and endoscopic management of mid-esophageal benign lesions: use of the prone patient position : Thoracoscopic surgery for mid-esophageal benign tumors and diverticula. Surg Endosc. 2008;22:250–4.

    Google Scholar 

  92. Cross FS, Johnson GF, Gerein AN. Esophageal diverticula. Associated neuromuscular changes in the esophagus. Arch Surg. 1961;83:525–33.

    Article  CAS  PubMed  Google Scholar 

  93. Chan DSY, Foliaki A, Lewis WG, Clark GWB, Blackshaw GRJC. Systematic review and meta-analysis of surgicaltreatment of Non-Zenker’s Oesophageal diverticula. J Gastrointest Surg. 2017;21:1067–75.

    Article  PubMed  PubMed Central  Google Scholar 

  94. Fernando HC, Luketich JD, Samphire J, Alvelo-Rivera M, Christie NA, Buenaventura PO, Landreneau RJ. Minimally invasive operation for esophageal diverticula. Ann Thorac Surg. 2005;80:2076–80.

    Article  PubMed  Google Scholar 

  95. Mou Y, Zeng H, Wang Q, Yi H, Liu W, Wen D, Tang C, Hu B. Giant mid-esophageal diverticula successfully treated by per-oral endoscopic myotomy. Surg Endosc. 2016;30:335–8.

    Article  PubMed  Google Scholar 

  96. Baker ME, Zuccaro G, Achkar E, Rice TW. Esophageal diverticula: patient assessment. Semin Thorac Cardiovasc Surg. 1999;11:326–36.

    Article  CAS  PubMed  Google Scholar 

  97. Abdollahimohammad A, Masinaeinezhad N, Firouzkouhi M. Epiphrenic esophageal diverticula. J Res Med Sci. 2014;19:795–7.

    PubMed  PubMed Central  Google Scholar 

  98. Nehra D, Lord RV, DeMeester TR, Theisen J, Peters JH, Crookes PF, Bremner CG. Physiologic basis for the treatment of epiphrenic diverticulum. Ann Surg. 2002;235:346–54.

    Article  PubMed  PubMed Central  Google Scholar 

  99. Soares R, Herbella FA, Prachand VN, Ferguson MK, Patti MG. Epiphrenic diverticulum of the esophagus. From pathophysiology to treatment. J Gastrointest Surg. 2010;14:2009–15.

    Article  PubMed  Google Scholar 

  100. Effler DB, Barr D, Groves LK. Epiphrenic diverticulum of the esophagus: surgical treatment. Arch Surg. 1959;79:459–67.

    Article  CAS  PubMed  Google Scholar 

  101. Rice TW, Goldblum JR, Yearsley MM, Shay SS, Reznik SI, Murthy SC, Mason DP, Blackstone EH. Myenteric plexus abnormalities associated with epiphrenic diverticula. Eur J Cardiothorac Surg. 2009;35:22–7; discussion 27.

    Article  PubMed  Google Scholar 

  102. Fasano NC, Levine MS, Rubesin SE, Redfern RO, Laufer I. Epiphrenic diverticulum: clinical and radiographic findings in 27 patients. Dysphagia. 2003;18:9–15.

    Article  PubMed  Google Scholar 

  103. Debas HT, Payne WS, Cameron AJ, Carlson HC. Physiopathology of lower esophageal diverticulum and its implications for treatment. Surg Gynecol Obstet. 1980;151:593–600.

    CAS  PubMed  Google Scholar 

  104. Varghese TK, Marshall B, Chang AC, Pickens A, Lau CL, Orringer MB. Surgical treatment of epiphrenic diverticula: a 30-year experience. Ann Thorac Surg. 2007;84:1801–9; discussion 1801-1809.

    Article  PubMed  Google Scholar 

  105. Altorki NK, Sunagawa M, Skinner DB. Thoracic esophageal diverticula. Why is operation necessary? J Thorac Cardiovasc Surg. 1993;105:260–4.

    Article  CAS  PubMed  Google Scholar 

  106. Fékéte F, Vonns C. Surgical management of esophageal thoracic diverticula. Hepato-Gastroenterology. 1992;39:97–9.

    PubMed  Google Scholar 

  107. Benacci JC, Deschamps C, Trastek VF, Allen MS, Daly RC, Pairolero PC. Epiphrenic diverticulum: results of surgical treatment. Ann Thorac Surg. 1993;55:1109–13; discussion 1114.

    Article  CAS  PubMed  Google Scholar 

  108. Orringer MB. Epiphrenic diverticula: fact and fable. Ann Thorac Surg. 1993;55:1067–8.

    Article  CAS  PubMed  Google Scholar 

  109. Tapias LF, Morse CR, Mathisen DJ, Gaissert HA, Wright CD, Allan JS, Lanuti M. Surgical management of esophageal epiphrenic diverticula: a transthoracic approach over four decades. Ann Thorac Surg. 2017;104:1123–30.

    Article  PubMed  Google Scholar 

  110. Kao AM, Arnold MR, Schlosser KA, Siddiqui SL, Prasad T, Colavita PD, Heniford BT. Epiphrenic diverticulum: 20-year single-institution experience. Am Surg. 2018;84:1159–63.

    Article  PubMed  Google Scholar 

  111. Klaus A, Hinder RA, Swain J, Achem SR. Management of epiphrenic diverticula. J Gastrointest Surg. 2003;7:906–11.

    Article  PubMed  Google Scholar 

  112. Streitz JM, Glick ME, Ellis FH. Selective use of myotomy for treatment of epiphrenic diverticula. Manometric and clinical analysis. Arch Surg. 1992;127:585–7; discussion 587–88.

    Article  PubMed  Google Scholar 

  113. Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, Satodate H, Odaka N, Itoh H, Kudo S. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42:265–71.

    Article  CAS  PubMed  Google Scholar 

  114. Demeter M, Bánovčin P, Ďuriček M, Kunda R, Hyrdel R. Peroral endoscopic myotomy in achalasia and large epiphrenic diverticulum. Dig Endosc. 2018;30:260–2.

    Article  PubMed  Google Scholar 

  115. Hudspeth DA, Thorne MT, Conroy R, Pennell TC. Management of epiphrenic esophageal diverticula. A fifteen-year experience. Am Surg. 1993;59:40–2.

    CAS  PubMed  Google Scholar 

  116. Castrucci G, Porziella V, Granone PL, Picciocchi A. Tailored surgery for esophageal body diverticula. Eur J Cardiothorac Surg. 1998;14:380–7.

    Article  CAS  PubMed  Google Scholar 

  117. Jordan PH, Kinner BM. New look at epiphrenic diverticula. World J Surg. 1999;23:147–52.

    Article  PubMed  Google Scholar 

  118. van der Peet DL, Klinkenberg-Knol EC, Berends FJ, Cuesta MA. Epiphrenic diverticula: minimal invasive approach and repair in five patients. Dis Esophagus. 2001;14:60–2.

    Article  PubMed  Google Scholar 

  119. Matthews BD, Nelms CD, Lohr CE, Harold KL, Kercher KW, Heniford BT. Minimally invasive management of epiphrenic esophageal diverticula. Am Surg. 2003;69:465–70; discussion 470.

    Article  PubMed  Google Scholar 

  120. Tedesco P, Fisichella PM, Way LW, Patti MG. Cause and treatment of epiphrenic diverticula. Am J Surg. 2005;190:891–4.

    Article  PubMed  Google Scholar 

  121. D’Journo XB, Ferraro P, Martin J, Chen L-Q, Duranceau A. Lower oesophageal sphincter dysfunction is part of the functional abnormality in epiphrenic diverticulum. Br J Surg. 2009;96:892–900.

    Article  PubMed  Google Scholar 

  122. Melman L, Quinlan J, Robertson B, Brunt LM, Halpin VJ, Eagon JC, Frisella MM, Matthews BD. Esophageal manometric characteristics and outcomes for laparoscopic esophageal diverticulectomy, myotomy, and partial fundoplication for epiphrenic diverticula. Surg Endosc. 2009;23:1337–41.

    Article  PubMed  Google Scholar 

  123. Soares RV, Montenovo M, Pellegrini CA, Oelschlager BK. Laparoscopy as the initial approach for epiphrenic diverticula. Surg Endosc. 2011;25:3740–6.

    Article  PubMed  Google Scholar 

  124. Fumagalli Romario U, Ceolin M, Porta M, Rosati R. Laparoscopic repair of epiphrenic diverticulum. Semin Thorac Cardiovasc Surg. 2012;24:213–7.

    Article  PubMed  Google Scholar 

  125. Zaninotto G, Parise P, Salvador R, Costantini M, Zanatta L, Rella A, Ancona E. Laparoscopic repair of epiphrenic diverticulum. Semin Thorac Cardiovasc Surg. 2012;24:218–22.

    Article  PubMed  Google Scholar 

  126. Rossetti G, Fei L, del Genio G, et al. Epiphrenic diverticula mini-invasive surgery: a challenge for expert surgeons--personal experience and review of the literature. Scand J Surg. 2013;102:129–35.

    Article  CAS  PubMed  Google Scholar 

  127. Bagheri R, Maddah G, Mashhadi MR, Haghi SZ, Tavassoli A, Ghamari MJ, Sheibani S. Esophageal diverticula: analysis of 25 cases. Asian Cardiovasc Thorac Ann. 2014;22:583–7.

    Article  PubMed  Google Scholar 

  128. Gonzalez-Calatayud M, Targarona EM, Balague C, Rodriguez-Luppi C, Martin AB, Trias M. Minimally invasive therapy for epiphrenic diverticula: systematic review of literature and report of six cases. J Minim Access Surg. 2014;10:169–74.

    Article  PubMed  PubMed Central  Google Scholar 

  129. Hauge T, Johnson E, Sandstad O, Johannessen H-O, Trondsen E. Surgical treatment of epiphrenic oesophageal diverticulum. Tidsskr Nor Laegeforen. 2014;134:1047–50.

    Article  PubMed  Google Scholar 

  130. Allaix ME, Borraez Segura BA, Herbella FA, Fisichella PM, Patti MG. Is resection of an esophageal epiphrenic diverticulum always necessary in the setting of achalasia? World J Surg. 2015;39:203–7.

    Article  PubMed  Google Scholar 

  131. Bowman TA, Sadowitz BD, Ross SB, Boland A, Luberice K, Rosemurgy AS. Heller myotomy with esophageal diverticulectomy: an operation in need of improvement. Surg Endosc. 2016;30:3279–88.

    Article  PubMed  Google Scholar 

  132. Macke RA, Luketich JD, Pennathur A, Bianco V, Awais O, Gooding WE, Christie NA, Schuchert MJ, Nason KS, Levy RM. Thoracic esophageal diverticula: a 15-year experience of minimally invasive surgical management. Ann Thorac Surg. 2015;100:1795–802.

    Article  PubMed  Google Scholar 

  133. Brandeis AE, Singhal S, Lee TH, Mittal SK. Surgical management of epiphrenic diverticulum: a single-center experience and brief review of literature. Am J Surg. 2018;216:280–5.

    Article  PubMed  Google Scholar 

  134. Kroh M, Reavis KM, editors. Chap. 18: Endoscopic interventions for the thoracic esophagus: Zenker’s and other diverticula. In: The SAGES manual: operating through the endoscope. Cham: Springer; 2016. https://doi.org/10.1007/978-3-319-24,145-6_18.

    Chapter  Google Scholar 

  135. Conigliaro R, Frazzoni M, editors. Chap. 11: Endoscopic and surgical management of Zenker’s diverticulum: new approaches. In: Diagnosis and endoscopic management of digestive diseases. Cham: Springer; 2017. https://doi.org/10.1007/978-3-319-42,358-6_11.

    Chapter  Google Scholar 

  136. Fisichella P, Patti M, editors. Chap. 11: Operations for Zenker’s diverticulum. In: Atlas of esophageal surgery. Cham: Springer; 2015.

    Chapter  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jeffrey L. Ponsky .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Strong, A.T., Ponsky, J.L. (2021). Esophageal Diverticula. In: Zundel, N., Melvin, W.S., Patti, M.G., Camacho, D. (eds) Benign Esophageal Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-51489-1_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-51489-1_15

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-51488-4

  • Online ISBN: 978-3-030-51489-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics