Esophagus Diverticulum

Question 1

Give examples of pulsion (false; mucosa and submucosa herniate through esophageal musculature) diverticula in the esophagus:

Answer 1

Zenker diverticulum and epiphrenic diverticulum

Question 2

What esophageal diverticulum is a traction (true) diverticulum that results from external inflammatory mediastinal lymph nodes adhering to the esophagus that heal and contract and pull the esophagus, resulting in the diverticulum?

Answer 2

Parabronchial (midesophageal) diverticulum

Question 3

Best initial test for diagnosis of esophageal diverticula?

Answer 3

Barium esophagram

Question 4

On what side are midesophageal diverticula usually found?

Answer 4

Typically present on the right secondary to the overabundance of structures in the midthoracic region of the left chest

Question 5

Treatment for a midesophageal diverticula:

Answer 5

If asymptomatic patient with inflamed mediastinal lymph nodes from tuberculosis or histoplasmosis, treat medically with antituberculin or antifungal agents; if diverticulum <2 cm, observe; if patient symptomatic or diverticulum >2 cm, perform diverticulopexy (suspend from thoracic vertebral fascia), and a long esophagomyotomy is indicated in patients with severe chest pain or dysphagia and a documented motor abnormality

Question 6

Treatment for epiphrenic diverticulum:

Answer 6

If diverticula <2 cm, perform diverticulopexy; in patients with severe chest pain, dysphagia, or a documented motor abnormality, perform long esophagomyotomy: if diverticulopexy, begin long esophagomyotomy at the neck of diverticulum and extend onto LES), and if diverticulectomy, perform esophagomyotomy on opposite esophageal wall, extending from the level of the diverticulum onto the LES; if large associated hiatal hernia, perform diverticulectomy, long esophagomyotomy, and repair of hiatal hernia

Question 7

Killian triangle (site of a Zenker diverticulum):

Answer 7

Point of potential weakness at the transition between the oblique fibers of the thyropharyngeus muscle and the horizontal fibers of the cricopharyngeus muscle

Question 8

The surgical treatment of a Zenker diverticulum:

Answer 8

If diverticulum >3 cm—cricopharyngeal myotomy with diverticulectomy with TA stapler versus invert and perform diverticulopexy to precervical fascia through a left neck incision

If <2 cm—leave alone

Question 9

The endoscopic treatment of Zenker diverticulum:

Answer 9

Dohlman procedure
The diverticulum is exposed with a bivalved (two-blade) endoscope with one blade in the pouch and the other blade in the cervical esophagus. Under direct visualization, the common wall between the pouch and the esophagus is ablated (usually with the carbon dioxide, CO2, laser