Surgery good option for Zenker’s diagnosis
DEAR DOCTOR: I have a Zenker’s diverticulum that, after 10 years, seems to be very large, judging by the volume it holds. At virtually every meal, I choke on food in my esophagus, then I aspirate and cough for 10 minutes. Are my aspiration-related pneumonia risks high enough to warrant surgery?
DEAR READER:
Think of the esophagus as a long tube connecting your mouth to your stomach. A Zenker’s diverticulum occurs when a pouch forms in the back of the esophagus because of a weakness of the constricting muscles. The pouch that forms can be small or very large.
When the pouch is large, more severe symptoms can occur, such as a mass in the neck, regurgitation of food into the mouth and potential aspiration of food into the lungs, which can lead to pneumonia. Your symptoms fit the description of a large diverticulum.
Because your symptoms are severe and pneumonia is dangerous, you should consider surgery. Traditionally, the removal of a diverticulum was done via an incision in the neck and then removal of the muscle layers that separate the diverticulum from the esophagus. This type of surgery resolves symptoms in 90-95 percent of patients. But complications include vocal cord paralysis, infection
and perforation of the esophagus.
Another option is to do the procedure by endoscopy. Rather than cutting into the neck, the surgeon goes through the mouth with a tube called an endoscope. This device allows the surgeon to look into the esophagus directly and then cut away the muscle — using a scalpel or a laser — separating the esophagus from the diverticulum.
The success rate of a procedure using a rigid endoscope, which has been in use since the 1960s, is 90 percent, with a complication rate of 8 percent. Use of a flexible endoscope, which has been available for about 20 years, does not require general anesthesia but often requires more than one treatment. The success rate is also about 90 percent, but the average rate of complications is lower, about 6 percent.
Because Zenker’s diverticulum is very rare, you should find a doctor who is experienced in either the open or endoscopic approaches.
Send your questions to askthedoctors@mednet. ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA 90095.