Zenker Diverticulum

What is it?

Zenker diverticulum (ZD) or (hypo)pharyngeal pouch is a problem that can develop in some people, usually at an older age, which causes increasing difficulty with swallowing. Food catches at the bottom of the throat, often needs to be regurgitated, and can cause coughing fits or choking. It is caused by the sphincter (valve) muscle at the top of the oesophagus (called the UES) not coordinating properly with the rest of the swallowing mechanism, and over time the pressure increase in the throat that results causes a diverticulum (pocket) to develop above the sphincter.

How is it treated?

The treatment of ZD is to cut the sphincter muscle to allow unimpeded passage of food into the oesophagus. Traditionally this has been performed by surgery through the side of the neck, or by ENT surgeons using long metal scissors through the mouth. Both of those approaches have their downsides, however, and in recent years a simpler approach offered by a few Gastroenterologists allows straightforward and effective treatment in all patients with this condition, including those of very advanced age.

Dr Rees Cameron is experienced and skilled in both the modified Zenker septotomy and Z-POEM techniques used to cure ZD and recommends these as the preferred ways to treat this condition over the surgical techniques used by ENT surgeons due to greater simplicity and safety. Using a flexible endoscope also allows an Advanced Endoscopist to perform these treatments on those who have stiff necks from arthritis.

Similarly, in some people, especially those with Parkinson’s disease, the UES does not relax properly during swallowing and this results in food getting stuck even without a ZD developing. The endoscopic treatment is similar to the treatment of a ZD but in this situation there is no surgical alternative.