Esophageal Diverticula

ByKristle Lee Lynch, MD, Perelman School of Medicine at The University of Pennsylvania
Reviewed/Revised Feb 2024
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An esophageal diverticulum is an outpouching of mucosa through the muscular layer of the esophagus. It can be asymptomatic or cause dysphagia and regurgitation. Diagnosis is made by barium swallow; surgical repair is rarely required.

(See also Overview of Esophageal and Swallowing Disorders.)

Types of Diverticula
Esophageal Diverticulum
Esophageal Diverticulum

This image shows a small diverticulum (arrow) in the upper esophagus.

Image provided by Kristle Lynch, MD.

Zenker Diverticulum
Zenker Diverticulum

Zenker diverticula are posterior outpouchings of mucosa and submucosa through the cricopharyngeal muscle. In this image, the diverticulum is on the left, next to the triangular opening of the trachea formed by the vocal cords.

... read more

Image provided by David M. Martin, MD.

Traction Diverticulum
Traction Diverticulum

Traction diverticula are midesophageal outpouchings of mucosa and submucosa caused by motility disorders or by traction resulting from mediastinal processes. In this image, the diverticulum is to the right of the esophagus and gives the appearance of a double lumen.

... read more

Image provided by David M. Martin, MD.

There are several types of esophageal diverticula, each of different origin:

  • Zenker (pharyngeal) diverticula are posterior outpouchings of mucosa and submucosa through the cricopharyngeal muscle, probably resulting from an incoordination between pharyngeal propulsion and cricopharyngeal relaxation.

  • Midesophageal (traction) diverticula are caused by traction resulting from mediastinal inflammatory lesions or, secondarily, by esophageal motility disorders.

  • Epiphrenic diverticula occur just above the diaphragm and usually accompany a motility disorder (eg, achalasia, distal esophageal spasm).

Symptoms and Signs of Esophageal Diverticula

A Zenker diverticulum fills with food that might be regurgitated when the patient bends or lies down. Aspiration pneumonitis may result if regurgitation is nocturnal. Rarely, the pouch becomes large, causing dysphagia and sometimes a palpable neck mass.

Traction and epiphrenic diverticula are rarely symptomatic, although their underlying cause may be.

Diagnosis of Esophageal Diverticula

  • Barium swallow

All diverticula are diagnosed by videotaped barium swallow and often confirmed on upper endoscopy.

Treatment of Esophageal Diverticula

  • Usually none

  • Sometimes surgical resection

Specific treatment is usually not required, although resection is occasionally necessary for large or symptomatic diverticula.

Diverticula associated with motility disorders require treatment of the primary disorder. For example, case reports suggest doing a cricopharyngeal myotomy when resecting a Zenker diverticulum. There are also endoscopic treatment options for diverticulectomy.

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