• Mucosal outpouching posteriorly between the Thyropharyngeus and Cricopharyngeus muscle (Kilian triangle).
• Pseudodiverticula.
• MC esophageal diverticula
Pathophysiology -
• Neuromuscular incordination
• Incomplete CP muscle relaxation
• Elevated resting tone of the entire upper esophageal sphincter
• Loss of CP muscle elasticity
Clinical Features -
• Dysphagia
• Chronic cough
• Age >50 years
• Halitosis
• Regurgitation
Association - Cervical webs (in 50%cases)
Fibrosis around diverticula is very common
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Diagnosis -
• Barium swallow - posterior midline pouch greater than 2 cm in diameter usually results in symptoms.
• Flexible endoscopic evaluation of swallowing (FEES)
• Endoscopy - to exclude presence of SCC.
Complications -
• Aspiration, Lung abscess, Pneumonia
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Management -
• Small (< 2 cm) lesions - no intervention
• Intermediate to large diverticula (2-6 cm) - open diverticulectomy with CP myotomy or by endoscopic diverticulotomy.
• Very large diverticula (> 6 cm) are best managed with excision with CP myotomy or a diverticulopexy with CP myotomy.
• Most common open procedure - diverticulectomy with CP myotomy
• Currently preferred treatment is endoscopic stapling (i.e. diverticulotomy with staples ) - Dohlman Procedure.
• Pseudodiverticula.
• MC esophageal diverticula
Pathophysiology -
• Neuromuscular incordination
• Incomplete CP muscle relaxation
• Elevated resting tone of the entire upper esophageal sphincter
• Loss of CP muscle elasticity
Clinical Features -
• Dysphagia
• Chronic cough
• Age >50 years
• Halitosis
• Regurgitation
Association - Cervical webs (in 50%cases)
Fibrosis around diverticula is very common
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Diagnosis -
• Barium swallow - posterior midline pouch greater than 2 cm in diameter usually results in symptoms.
• Flexible endoscopic evaluation of swallowing (FEES)
• Endoscopy - to exclude presence of SCC.
Complications -
• Aspiration, Lung abscess, Pneumonia
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Management -
• Small (< 2 cm) lesions - no intervention
• Intermediate to large diverticula (2-6 cm) - open diverticulectomy with CP myotomy or by endoscopic diverticulotomy.
• Very large diverticula (> 6 cm) are best managed with excision with CP myotomy or a diverticulopexy with CP myotomy.
• Most common open procedure - diverticulectomy with CP myotomy
• Currently preferred treatment is endoscopic stapling (i.e. diverticulotomy with staples ) - Dohlman Procedure.
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