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The New England Journal of Medicine Nov 2017
Topics: Aged; Deglutition Disorders; Esophagus; Humans; Laryngopharyngeal Reflux; Male; Radiography; Zenker Diverticulum
PubMed: 29171816
DOI: 10.1056/NEJMicm1701620 -
VideoGIE : An Official Video Journal of... Mar 2021
PubMed: 33738355
DOI: 10.1016/j.vgie.2020.11.004 -
Surgical Case Reports Feb 2023Killian-Jamieson diverticulum, which is a relatively rare pharyngoesophageal diverticulum, is difficult to distinguish from Zenker's diverticulum. Because major points...
BACKGROUND
Killian-Jamieson diverticulum, which is a relatively rare pharyngoesophageal diverticulum, is difficult to distinguish from Zenker's diverticulum. Because major points of the relevant surgical procedures for these two entities differ, it is important to make an accurate diagnosis. We herein report a case of Killian-Jamieson diverticulum initially diagnosed as Zenker's diverticulum.
CASE PRESENTATION
A 56-year-old man complaining of discomfort during swallowing was diagnosed with pharyngoesophageal diverticulum. He was initially diagnosed with Zenker's diverticulum before surgery, but the diverticulum actually arose from the left side of the esophageal wall, at the level of the cricoid cartilage and below the cricopharyngeal muscle. We therefore ultimately diagnosed this case as Killian-Jamieson diverticulum during surgery, and were able to preserve the muscle above the diverticulum, which would normally have to be cut when treating a case of Zenker's diverticulum.
CONCLUSION
To make an accurate diagnosis, clinical and surgical findings are important to consider, including the location of the diverticulum and the relationship between the diverticula and cricopharyngeal muscles or between the diverticula, thyroid cartilage and cricoid cartilage.
PubMed: 36759360
DOI: 10.1186/s40792-023-01599-7 -
Insights Into Imaging Jun 2017Non-malignant oesophageal diseases are critical to recognize, but can be easily overlooked or misdiagnosed radiologically. In this paper, we cover the salient clinical... (Review)
Review
UNLABELLED
Non-malignant oesophageal diseases are critical to recognize, but can be easily overlooked or misdiagnosed radiologically. In this paper, we cover the salient clinical features and imaging findings of non-malignant pathology of the oesophagus. We organize the many non-malignant diseases of the oesophagus into two major categories: luminal disorders and wall disorders. Luminal disorders include dilatation/narrowing (e.g. achalasia, scleroderma, and stricture) and foreign body impaction. Wall disorders include wall thickening (e.g. oesophagitis, benign neoplasms, oesophageal varices, and intramural hematoma), wall thinning/outpouching (e.g. epiphrenic diverticulum, Zenker diverticulum, and Killian-Jamieson diverticulum), wall rupture (e.g. iatrogenic perforation, Boerhaave Syndrome, and Mallory-Weiss Syndrome), and fistula formation (e.g. pericardioesophageal fistula, tracheoesophageal fistula, and aortoesophageal fistula). It is the role of the radiologist to recognize the classic imaging patterns of these non-malignant oesophageal diseases to facilitate the delivery of appropriate and prompt medical treatment.
TEACHING POINTS
• Nonmalignant oesophageal disease can be categorised by the imaging appearance of wall and lumen. • Scleroderma and achalasia both cause lumen dilatation via different pathophysiologic pathways. • Oesophageal wall thickening can be inflammatory, neoplastic, traumatic, or vascular in aetiology.
PubMed: 28303554
DOI: 10.1007/s13244-017-0548-3 -
Multimedia Manual of Cardiothoracic... Jan 2009The cricopharyngeal diverticulum or Zenker's diverticulum is the most frequent type of diverticulum of the upper gastrointestinal tract. It occurs mostly in elderly...
The cricopharyngeal diverticulum or Zenker's diverticulum is the most frequent type of diverticulum of the upper gastrointestinal tract. It occurs mostly in elderly patients. The predominant symptoms are dysphagia and regurgitation which may result in malnutrition and aspiration pneumonia, the latter eventually being life threatening. The underlying cause of Zenker's diverticulum is a dysfunction of the cricopharyngeal muscle and the upper esophageal sphincter, the most common finding being a decreased compliance. The treatment consists in a myotomy of the upper esophageal sphincter and cricopharyngeal muscle combined with a diverticulopexy or diverticulectomy. This procedure is performed via a limited left cervicotomy. Results are excellent to very good in 94% of the patients in our own experience.
PubMed: 24412952
DOI: 10.1510/mmcts.2007.002881 -
Clinical Endoscopy Jan 2023Submucosal endoscopy or third-space endoscopy utilizes the potential space between the mucosal and muscularis layers of the gastrointestinal tract to execute therapeutic... (Review)
Review
Submucosal endoscopy or third-space endoscopy utilizes the potential space between the mucosal and muscularis layers of the gastrointestinal tract to execute therapeutic interventions for various diseases. Over the last decade, endoscopic access to the submucosal space has revolutionized the field of therapeutic endoscopy. Submucosal endoscopy was originally used to perform endoscopic myotomy in patients with achalasia cardia, and its use has grown exponentially since. Currently, submucosal endoscopy is widely used to resect subepithelial tumors and to manage refractory gastroparesis and Zenker's diverticulum. While the utility of submucosal endoscopy has stood the test of time in esophageal motility disorders and subepithelial tumors, its durability remains to be established in conditions such as Zenker's diverticulum and refractory gastroparesis. Other emerging indications for submucosal endoscopy include esophageal epiphrenic diverticulum, Hirschsprung's disease, and esophageal strictures not amenable to conventional endoscopic treatment. The potential of submucosal endoscopy to provide easy and safe access to the mediastinum and peritoneal spaces may open doors to novel indications and rejuvenate the interest of endoscopists in natural orifice transluminal endoscopic surgery in the future. This review focuses on the current spectrum, recent updates, and future direction of submucosal endoscopy in the gastrointestinal tract.
PubMed: 36617645
DOI: 10.5946/ce.2022.139 -
VideoGIE : An Official Video Journal of... Dec 2021Zenker's diverticulum (ZD) is attributed to a poorly compliant cricopharyngeus muscle, and the mainstay of treatment is a cricopharyngeal myotomy. We present a video...
BACKGROUND AND AIMS
Zenker's diverticulum (ZD) is attributed to a poorly compliant cricopharyngeus muscle, and the mainstay of treatment is a cricopharyngeal myotomy. We present a video series summarizing endoscopic treatment options for ZD and related conditions.
METHODS
We review the rationale and key technique for various endoscopic treatment modalities for ZD, cricopharyngeal bar, and other esophageal diverticula.
RESULTS
Standard flexible endoscopic cricopharyngeal myotomy involves the division of the common wall or septum of the ZD, aiming for complete transection of the cricopharyngeus. However, recurrence rates are high, likely owing to incomplete myotomy. Zenker's peroral endoscopic myotomy (Z-POEM) uses a proximal submucosal tunnel to provide direct visualization of the cricopharyngeus and septum, allowing confirmation of complete myotomy. We demonstrate an over-the-septum modification to simplify the technique. Submucosal fibrosis, commonly seen in patients with prior treatment, limits submucosal dissection. We present a hybrid technique to overcome this, whereby a traditional septotomy is performed until submucosal tissue is visualized. The intact mucosal flap after Z-POEM in a large ZD may contribute to residual dysphagia. We propose Z-POEM with mucosotomy for large ZD. Finally, we demonstrate modifications for treatment of other esophageal diseases, including cricopharyngeal bar and non-Zenker's esophageal diverticula.
CONCLUSION
Endoscopic treatment options for ZD and related conditions are rapidly expanding. With careful tailoring to individual patient characteristics, our expanding arsenal of options allows effective and safe treatment of a broad spectrum of patients.
PubMed: 34917870
DOI: 10.1016/j.vgie.2021.08.003 -
JAMA Otolaryngology-- Head & Neck... Mar 2022The incidence of Zenker diverticulum has been established; previous estimates have been extrapolated from small institutional cohorts.
IMPORTANCE
The incidence of Zenker diverticulum has been established; previous estimates have been extrapolated from small institutional cohorts.
OBJECTIVE
To describe the population-wide incidence of Zenker diverticulum over a 20-year period and characterize management strategies across specialties and treatment settings.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective national cohort study was conducted from January 1, 1996, through December 31, 2015, and reviewed patient records from the Care Register for Healthcare in Finland, from which patients with Zenker diverticulum were identified. The data were analyzed in October 2021.
EXPOSURES
Zenker diverticulum.
MAIN OUTCOME AND MEASURE
The incidence of Zenker diverticulum per 100 000 person-years.
RESULTS
A total of 2736 patients (median [IQR] age at diagnosis 72.0 [19-106] years; 1278 women [46.7%]) were identified, making the annual incidence of Zenker diverticulum in Finland 2.9/100 000 person-years. Men had higher incidence (3.7/100 000 person-years) compared with women (2.3/100 000 person-years), with an incidence rate ratio of 1.61 (95% CI, 1.48-1.76; P < .001). Within the study population, 1044 patients (38.2%) underwent surgical treatment and 227 (8.3%) underwent 2 or more surgeries. The choice of initial operative approach depended on the medical specialty (Cramer V = 0.41) and on specific catchment area (Cramer V = 0.41). Overall, endoscopic approaches for initial operations were most popular.
CONCLUSIONS AND RELEVANCE
The cohort study results found that the incidence of Zenker diverticulum was 2.9/100 000 person-years. Most patients with Zenker diverticulum did not undergo definitive therapy. Some hospital districts and some medical specialties were more likely to opt for conservative treatment than others. The choice of operative approach depended more on physician-level factors rather than patient profiles.
Topics: Cohort Studies; Delivery of Health Care; Female; Finland; Humans; Male; Retrospective Studies; Treatment Outcome; Zenker Diverticulum
PubMed: 34913965
DOI: 10.1001/jamaoto.2021.3671