What is the role of barium swallow with videofluoroscopy in the workup of Zenker diverticulum?

Updated: Feb 25, 2020
  • Author: Joel A Ernster, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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The criterion standard of confirmatory evaluations is the barium swallow with videofluoroscopy. This study provides information about the size, location, and character of the mucosal lining of the Zenker diverticulum, as depicted in the image below. Certain radiographic features of the diverticulum neck may predict the likelihood of success of the endoscopic stapling approach. [18]

Images obtained during barium swallow videofluoros Images obtained during barium swallow videofluoroscopy demonstrating an intermediate-sized Zenker diverticulum.

Patients with symptomatic disease usually have a posterior midline pouch greater than 2 cm in diameter arising just above the cricopharyngeus (CP) muscle. No other study is required if no other abnormality is present. [11, 12] (See the image below.)

Illustrated barium swallow demonstrates the pouch Illustrated barium swallow demonstrates the pouch retaining contrast and its connection to the esophagus immediately inferior and posterior to the larynx.

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