How are small lesions in Zenker diverticulum treated?

Updated: Oct 16, 2020
  • Author: Joel A Ernster, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Zenker diverticula require intervention only if they produce symptoms. In general, small (ie, < 2 cm) lesions found incidentally require no intervention. However, some surgeons contend that because these lesions are likely to become larger with time, intervention ought to be considered in younger, healthier, asymptomatic patients with Zenker diverticula.

Small lesions are satisfactorily treated with a cricopharyngeus (CP) myotomy with or without an invagination procedure. Intermediate and large diverticula (ie, 2-6 cm) are best managed with open diverticulectomy with CP myotomy or by endoscopic diverticulotomy. Very large diverticula (ie, >6 cm) are best managed with excision with CP myotomy or a diverticulopexy with CP myotomy, depending on the health of the patient. On one occasion, the authors placed a gastrostomy as the sole form of intervention for an ill patient aged 95 years with a 20-cm Zenker diverticulum.

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