Esophageal Diverticula: Types, Causes, Symptoms, Diagnosis, and Treatment w/ Dr. Ashley Walther
With Dr. Ashley Walther · hosted by Dr. Jill Knepprath
Chapter 1 of 9 · Fundamentals
Classification
Introduction and Classification of Esophageal Diverticula
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Dr. Ashley WaltherWhat the experts said
There are three main types of esophageal diverticula: pharyngoesophageal, mid-esophageal, and epiphrenic
Pharyngoesophageal diverticula are pulsion false type that happen up high and are famously known as Zenker's
Mid-esophageal diverticula are traction type or true and contain all three layers of the esophagus
Epiphrenic diverticula are false type and happen down low
Acquired diverticula can result from delayed post-op complication after esophageal atresia repair
Acquired diverticula can result from iatrogenic injury following OG/NG insertion, especially in neonates
Zenker's diverticula occur in the cervical region proximal to the cricopharyngeal muscle
Zenker's diverticula happen because of increased intraluminal pressure in the oropharynx and herniation of the mucosa between the cricopharyngeal muscle and the inferior pharyngeal constrictor muscles
Mid-esophageal diverticula are caused by inflammatory processes with mediastinal inflammation including TB, histoplasmosis, sarcoidosis, some sort of infection in that area, or treatment for non-Hodgkin's lymphoma
Epiphrenic diverticula are pulsion in nature, often due to a functional obstruction at the distal esophagus
Zenker's diverticula present often with dysphagia, noisy swallowing, bad breath, and spontaneous regurgitation of undigested food with coughing or choking
Esophagrams provide significant diagnostic information for esophageal diverticula
Workup includes endoscopy to measure the longitudinal extension of the pouch
Manometry is used for epiphrenic diverticula to figure out why the diverticula is happening
For mid-esophageal diverticula, treatment involves addressing the underlying inflammatory process
For epiphrenic diverticula, diverticulectomy and myotomy can be performed, but usually treating the underlying cause will cause improvement
Esophageal diverticula can be congenital or acquired
An acquired diverticula could be from a retained esophageal foreign body
Zenker's diverticula are the most common esophageal diverticula overall but are not common in the pediatric population
Mid-esophageal diverticula occur near the trachea and are caused by external traction
Epiphrenic diverticula occur along the right posterior wall
Epiphrenic diverticula are often caused by previous fundoplication or from a dysmotility disorder like achalasia
Mid-esophageal and epiphrenic diverticula can present with regurgitation, dysphagia, chest pain, early satiety, and weight loss
Treatment for pharyngoesophageal diverticula includes a left cervical approach where the cricopharyngeal muscle is cut and the diverticula is resected
If mid-esophageal diverticula persist after treating inflammation, surgical options include right thoracotomy or thoracoscopic surgery to divide the diverticula and close the esophagus in layers