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A. Introduction

  1. Uncommon
  2. Zenker's (upper)
  3. Middle
  4. Epiphrenic (lower)

B. Etiology

  1. Zenker's and epiphrenic from increased pressure in sphincter zone
  2. Mid-esophageal diverticuli may be due to tuberculosis

C. Symptoms

  1. Regurgitation
  2. Dysphagia
  3. Substernal (Atypical) Chest Pain (if infected)

D. Diagnosis

  1. Barium Swallow
  2. Endoscopy - may perforate so barium swallow usually done first

E. Therapy

  1. Myotomy - muscle is split in only one area
  2. Pneumatic dilatation in areas of narrowing
  3. May need anti-reflux medications
  4. Laparoscoipic resection of diverticula (diverticulectomy) now possible [3,4]

References

  1. Achkar E. 1998. Dig Dis. 16(3):144 abstract
  2. Ferraro P and Duranceau A. 1994. Chest Surg Clin N Am. 4(4):741 abstract
  3. Renz EM, Parker MV, Hetz SP. 2002. Curr Surg. 5992):190
  4. Altman JI, Genden EM, Moche J. 2005. Ann Otol Rhinol Laryngol. 114(5);347 abstract