Zenker’s Diverticulum in Singapore

The primary cause of Zenker’s diverticulum is dysfunction of the cricopharyngeal muscle, which acts as a valve between the throat and oesophagus. When this muscle fails to relax properly during swallowing, increased pressure builds up above it. This pressure may eventually cause the weakest point in the pharyngeal wall to bulge outward, forming the diverticulum.

Age-related changes in muscle coordination and tissue elasticity can contribute to this dysfunction. The repeated pressure from swallows over time may gradually create and enlarge the pouch.

• Advanced age (commonly observed in older adults)
• Male gender (men are affected more frequently than women)
• Gastro-oesophageal reflux disease (GORD)
• Previous neck trauma or surgery
• Certain neurological conditions affecting swallowing
• Chronic increased pressure during swallowing
• Connective tissue disorders
• History of radiotherapy to the neck area

For small, minimally symptomatic diverticula, dietary changes may help manage symptoms. This includes eating softer foods, taking smaller bites, chewing thoroughly, and drinking plenty of water with meals. Avoiding foods that are easy to lodge in the pouch, such as pills, nuts, and seeds, may reduce discomfort. Sitting upright during and after meals may help prevent regurgitation.

This minimally invasive procedure involves cutting the cricopharyngeal muscle using specialised endoscopic instruments. The method can be performed through the mouth without external incisions. By releasing the tight muscle, pressure may be reduced, and the diverticulum may shrink. Recovery is typically quick, with patients often resuming a regular diet within days.

Using a flexible endoscope, the wall between the diverticulum and oesophagus is divided, creating a common channel. This technique may be suitable for smaller diverticula and patients who may not tolerate general anaesthesia well. The procedure is often performed under sedation as a day surgery.

This established technique uses a rigid endoscope and specialised staplers, or a laser, to divide the party wall between the pouch and the oesophagus. The procedure aims to eliminate the pouch while addressing the underlying muscle dysfunction. Patients may experience improvement in swallowing after recovery.

Traditional surgery involves making an incision in the neck to remove the diverticulum completely. The cricopharyngeal muscle is also divided to help prevent recurrence. This approach may be considered for very large diverticula or when endoscopic approaches are not suitable. Recovery takes longer but aims to provide comprehensive treatment.

This surgical technique involves suspending the diverticulum upward without removing it. The pouch is positioned to prevent food accumulation. This approach may be considered for patients with specific anatomical considerations or medical conditions that make complete removal risky.