Zenker's diverticulum natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
The [[Zenker's diverticulum]] (ZD) slowly | The development of [[Zenker's diverticulum]] (ZD) slowly starts as a [[oropharyngeal]] [[dysphagia]] progressing from solids to liquids, [[regurgitation]] of undigested food from the [[diverticular]] sac, [[chronic]] [[aspiration]], [[halitosis]], [[chronic]] [[cough]], sensation of a [[lump]] in the [[throat]], [[hoarseness]], [[borborygmi]]. If left untreated, ZD may lead to [[complications]] such as [[aspiration pneumonia]], [[bleeding]] from the [[diverticulum]], [[Ulcer|ulceration]] of the [[diverticulum]], compression of the [[trachea]] and [[esophageal]] obstruction with large [[Diverticular|diverticula]], [[perforation]], very rarely [[squamous cell carcinoma]] of the [[diverticulum]]. Patients who undergo [[surgery]] have a very low rate of recurrence for [[Zenker's Divertitulum|ZD]]. | ||
==Natural History== | ==Natural History== | ||
*Symptoms of [[Zenker's diverticulum]] slowly start as a<ref name="urlZenkers diverticulum: exploring treatment options">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3773964/ |title=Zenker's diverticulum: exploring treatment options |format= |work= |accessdate=}}</ref> | *[[Symptoms]] of [[Zenker's diverticulum]] slowly start as a<ref name="urlZenkers diverticulum: exploring treatment options">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3773964/ |title=Zenker's diverticulum: exploring treatment options |format= |work= |accessdate=}}</ref> | ||
** Oropharyngeal [[dysphagia]] progressing from solids to liquids | ** Oropharyngeal [[dysphagia]] progressing from solids to liquids | ||
** [[Regurgitation]] of undigested food from the [[diverticular]] sac | ** [[Regurgitation]] of undigested food from the [[diverticular]] sac | ||
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*The patient may note food on the pillow upon awakening in the morning. | *The patient may note food on the pillow upon awakening in the morning. | ||
*Although small [[Diverticular|diverticula]] may not cause symptoms, larger [[Diverticular|diverticula]] usually are symptomatic. | *Although small [[Diverticular|diverticula]] may not cause [[symptoms]], larger [[Diverticular|diverticula]] usually are [[symptomatic]]. | ||
*Both the inability of the [[sphincter]] to fully open and the extrinsic compression from the pouch itself are likely to explain the [[dysphagia]] experienced by patients. | *Both the inability of the [[sphincter]] to fully open and the extrinsic compression from the pouch itself are likely to explain the [[dysphagia]] experienced by patients. | ||
*In patients with very large [[Diverticular|diverticula]], a gurgling [[swelling]] in the neck can occasionally be detected on [[palpation]]. | *In patients with very large [[Diverticular|diverticula]], a gurgling [[swelling]] in the [[neck]] can occasionally be detected on [[palpation]]. | ||
==Complications== | ==Complications== | ||
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* [[Ulceration]] of the [[diverticulum]] | * [[Ulceration]] of the [[diverticulum]] | ||
* Compression of the [[trachea]] and [[esophageal]] [[obstruction]] with large [[Diverticular|diverticula]] | * Compression of the [[trachea]] and [[esophageal]] [[obstruction]] with large [[Diverticular|diverticula]] | ||
* Very rarely [[ | * Very rarely [[squamous cell carcinoma]] of the diverticulum | ||
* [[Perforation]] of the [[diverticulum]] during the [[endoscopy]] | * [[Perforation]] of the [[diverticulum]] during the [[endoscopy]]. Hence scopes with side viewing should be used to [[Prevention|prevent]] [[perforation]]. | ||
==Prognosis== | ==Prognosis== | ||
Prognosis of [[Zenker's diverticulum|ZD]] after the intervention is good, the recurrence of the [[diverticulum]] is very rare.<ref name="urlwww.sciencedirect.com.ezp-prod1.hul.harvard.edu">{{cite web |url=http://www.sciencedirect.com.ezp-prod1.hul.harvard.edu/science/article/pii/S0003497502039310 |title=www.sciencedirect.com.ezp-prod1.hul.harvard.edu |format= |work= |accessdate=}}</ref> | [[Prognosis]] of [[Zenker's diverticulum|ZD]] after the intervention is good, the recurrence of the [[diverticulum]] is very rare.<ref name="urlwww.sciencedirect.com.ezp-prod1.hul.harvard.edu">{{cite web |url=http://www.sciencedirect.com.ezp-prod1.hul.harvard.edu/science/article/pii/S0003497502039310 |title=www.sciencedirect.com.ezp-prod1.hul.harvard.edu |format= |work= |accessdate=}}</ref> | ||
==References== | ==References== | ||
Revision as of 14:39, 5 December 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
Overview
The development of Zenker's diverticulum (ZD) slowly starts as a oropharyngeal dysphagia progressing from solids to liquids, regurgitation of undigested food from the diverticular sac, chronic aspiration, halitosis, chronic cough, sensation of a lump in the throat, hoarseness, borborygmi. If left untreated, ZD may lead to complications such as aspiration pneumonia, bleeding from the diverticulum, ulceration of the diverticulum, compression of the trachea and esophageal obstruction with large diverticula, perforation, very rarely squamous cell carcinoma of the diverticulum. Patients who undergo surgery have a very low rate of recurrence for ZD.
Natural History
- Symptoms of Zenker's diverticulum slowly start as a[1]
- Oropharyngeal dysphagia progressing from solids to liquids
- Regurgitation of undigested food from the diverticular sac
- Pharyngeal stasis of secretion
- Chronic aspiration
- Halitosis
- Chronic cough
- Sensation of a lump in the throat
- Hoarseness
- Cervical borborygmi.
- The patient may note food on the pillow upon awakening in the morning.
- Although small diverticula may not cause symptoms, larger diverticula usually are symptomatic.
- Both the inability of the sphincter to fully open and the extrinsic compression from the pouch itself are likely to explain the dysphagia experienced by patients.
- In patients with very large diverticula, a gurgling swelling in the neck can occasionally be detected on palpation.
Complications
- Complications of the Zenker's diverticulum includes[2][3][4][5]
- Aspiration pneumonia
- Bleeding of the diverticulum
- Ulceration of the diverticulum
- Compression of the trachea and esophageal obstruction with large diverticula
- Very rarely squamous cell carcinoma of the diverticulum
- Perforation of the diverticulum during the endoscopy. Hence scopes with side viewing should be used to prevent perforation.
Prognosis
Prognosis of ZD after the intervention is good, the recurrence of the diverticulum is very rare.[6]
References
- ↑ "Zenker's diverticulum: exploring treatment options".
- ↑ "Long-term survival following diverticulectomy for cancer in pharyngoesophageal (Zenker's) diverticulum. - PubMed - NCBI".
- ↑ "Esophageal diverticula and cancer. - PubMed - NCBI".
- ↑ "The treatment of pharyngoesophageal diverticulum: the simple and complex. - PubMed - NCBI".
- ↑ "Carcinoma arising in posterior pharyngeal pulsion diverticulum (Zenker's diverticulum). - PubMed - NCBI".
- ↑ "www.sciencedirect.com.ezp-prod1.hul.harvard.edu".