General approach to Zenker’s diverticulum: a narrative review

Abstract

Objective: To report the general approach to Zenker's Diverticulum (ZD), covering everything from epidemiology to treatment. Bibliographic review: ZD is a relatively rare condition found in the esophagus, in the posterior muscular wall of the hypopharynx and has a higher incidence in elderly males. The pathophysiology is still controversial, it is believed that it is a multifactorial process in which forces contribute to the increase of pressure in the esophageal lumen, developing its evagination. Initially, patients are asymptomatic and over time, with the increase in diverticular sacs, symptoms appear. The diagnosis is made through barium swallowing, the most important test, where there will be typical enlargement on the dorsal surface of the esophagus. Ultrasonography is the alternative diagnostic test for those patients with a contraindication or difficulty in taking barium. Treatment is performed surgically or endoscopically, with no consensus on which technique is more appropriate, but most studies show a preference for the surgical procedure, with complete removal of the diverticulum. Final considerations: ZD is a rare disease, with an asymptomatic onset and that can be confused with other more prevalent pathologies. When present, it should be treated surgically or endoscopically.