Esophageal diverticula

Last updated: November 18, 2021

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Esophageal diverticula are abnormal pouches that arise from the wall of the esophagus. They most commonly occur in middle-aged and older men and are classified based on localization, pathophysiology, and histological findings. The most common type of esophageal diverticula is Zenker diverticulum, which extends posteriorly in the hypopharynx directly proximal to the upper esophageal sphincter. Esophageal diverticula can be caused by either an underlying motility disorder that exerts high intraluminal pressures on a weak esophageal wall or from forces pulling on the outside of the esophagus. The clinical presentation varies with pouch size and localization, with the most common symptoms being dysphagia, regurgitation, retrosternal pain, and pulmonary symptoms secondary to aspiration. The diagnosis is confirmed by barium swallow, which also aids in determining the size of the diverticulum and potential malignancy. Surgical treatment is rarely required and only recommended in symptomatic patients (primarily those with Zenker diverticula).

  • Rare diverticula compared to other gastrointestinal sites [1]
  • Peak incidence: middle-aged and older male individuals [2]
  • Zenker diverticulum is the most common type. [3]

Epidemiological data refers to the US, unless otherwise specified.

Esophageal diverticula are classified according to their localization, histology, and pathophysiology. [1]


Zenker diverticulum arises from the hypopharynx, although it is classified as an esophageal diverticulum.



Clinical presentation depends on diverticulum size and localization. [1][4]

Elder MIKE has bad breath: Elderly, Male individuals, Inferior pharyngeal constrictor, Killian triangle, Esophageal dysmotility, halitosis.

  • Barium swallow (best confirmatory test) with dynamic continuous fluoroscopy ; [3]
    • Visualization of diverticula via barium swallow or gastrografin (soluble in water)
    • Allows for the detection of underlying motor abnormalities and diverticulum size [5]
    • A traction diverticulum presents as a pointed, triangular bulge arising from the esophageal wall; the base of the triangle is oriented towards the wall.
  • Endoscopy [5]
    • Indication: to rule out malignancy in the pouch and exclude other causes of the patient's symptoms (e.g., tumor and reflux esophagitis)
    • Less sensitive, since diverticula with small openings may be missed
    • Risk of diverticulum perforation (since the course of the esophagus is often irregular) [1]

Diverticula of the middle and distal esophagus rarely require any treatment since most of them are asymptomatic. [1]

We list the most important complications. The selection is not exhaustive.

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  2. Bizzotto A, Iacopini F, Landi R, Costamagna G. Zenker's diverticulum: exploring treatment options.. Acta Otorhinolaryngol Ital. 2013; 33 (4): p.219-29.
  3. Mulder CJJ, van Delft F. Zenker's diverticulum. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. updated: November 17, 2014. Accessed: December 21, 2016.
  4. Ballehaninna UK, Shaw JP, Brichkov I. Traction esophageal diverticulum: a rare cause of gastro-intestinal bleeding. SpringerPlus. 2012; 1 (1): p.50. doi: 10.1186/2193-1801-1-50 . | Open in Read by QxMD
  5. Nuño-Guzmán CM, García-Carrasco D, Haro M, Arróniz-Jáuregui J, Corona JL, Salcido M. Zenker's Diverticulum: Diagnostic Approach and Surgical Management. Case Rep Gastroenterol. 2014; 8 (3): p.346-352.
  6. Abdollahimohammad A, Masinaeinezhad N, Firouzkouhi M. Epiphrenic esophageal diverticula.. Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences. 2014; 19 (8): p.795-7.
  7. Lixin J, Bing H, Zhigang W, Binghui Z. Sonographic diagnosis features of Zenker diverticulum. Eur J Radiol. 2011; 80 (2): p.e13-e19. doi: 10.1016/j.ejrad.2010.05.028 . | Open in Read by QxMD
  8. 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 (6): p.1801-1809. doi: 10.1016/j.athoracsur.2007.06.057 . | Open in Read by QxMD
  9. Choi AR, Chon NR, Youn YH, Paik HC, Kim YH, Park H. Esophageal cancer in esophageal diverticula associated with achalasia.. Clinical endoscopy. 2015; 48 (1): p.70-3. doi: 10.5946/ce.2015.48.1.70 . | Open in Read by QxMD

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