Review
Pharyngeal pouch (Zenker's diverticulum)
M A Siddiq, S Sood, D Strachan
Department of
Otorhinolaryngology, Head and Neck Surgery, Bradford Royal Infirmary,
Duckworth Lane, Bradford BD9 6RJ, UK
Correspondence to: Mr Siddiq azher{at}excite.co.uk
Submitted 26 September
2000;
Accepted 7 November 2000
Pharyngeal pouches occur most commonly in elderly patients
(over 70 years) and typical symptoms include dysphagia, regurgitation, chronic cough, aspiration, and weight loss. The aetiology remains unknown but theories centre upon a structural or physiological abnormality of the cricopharyngeus. A diagnosis is easily established on barium studies. Treatment is surgical via an endoscopic or external
cervical approach and should include a cricopharyngeal myotomy.
Unfortunately pharyngeal pouch surgery has long been associated with
significant morbidity, partly due to the surgery itself and also to the
fact that the majority of patients are elderly and often have general
medical problems. External approaches are associated with higher
complication rates than endoscopic procedures. Recently, treatment by
endoscopic stapling diverticulotomy has becoming increasingly popular
as it has distinct advantages, although long term results are not yet
available. The small risk of developing carcinoma within a pouch that
is not excised remains a contentious issue and is an argument for long
term follow up or treating the condition by external excision,
particularly in younger patients.
Keywords: Zenker's diverticulum; surgical procedures: endoscopic; surgical stapling
© 2001 by The Fellowship of Postgraduate Medicine
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