In the literature, various theories concerning the cause of Zenker's diverticulum have been propounded. I believe that an anatomic predisposition plays a prominent role in the pathogenesis. This conclusion will be discussed in light of a study of the literature and characteristics of a series of 646 patients with Zenker's diverticulum. The current methods of treatment by an external surgical approach, as well as the (micro)endoscopic procedures, are described.
ZenkerFA. Handbuch der Krankheiten des Chylopoëtischen Apparates. Leipzig, 1878.
2.
ZainoCJacobsonHGLepowH. The pharyngoesophageal sphincter. Springfield, Ill: Thomas, 1970.
3.
WinansCS. The pharyngoesophageal closure mechanism: A manometric study. Gastroenterology1972; 63: 768–77.
4.
van OverbeekJJMWitHPPapingRHLSegenhoutHM. Simultaneous manometry and electromyography in the pharyngoesophageal segment. Laryngoscope1985; 95: 582–4.
5.
BrownlowHWhitmoreIWillanPLT. A quantitative study of the histochemical and morphometric characteristics of the human cricopharyngeus muscle. J Anat1989; 166: 67–75.
6.
KristmundsdottirFMahonMFroesMMQCummingWJ. Histomorphometric and histopathological study of the human cricopharyngeus muscle: In health and in motor neuron disease. Neuropathol Appl Neurobiol1990; 16: 461–75.
7.
CookIJBlumbergsPCashKJamiesonGGShearmanDJ. Structural abnormalities of cricopharyngeus mucle in patients with pharyngeal (Zenker's) diverticulum. J Gastroenterol Hepatol1992; 7: 556–62.
8.
LerutTvan RaemdonckDGuelinckxPDomRGeboesK. Zenker's diverticulum: Is a myotomy of the cricopharyngeus useful? How long should it be?Hepatogastroenterology1992; 39: 127–31.
9.
van OverbeekJJM. The hypopharyngeal diverticulum. Endoscopic treatment and manometry. Assen, the Netherlands: Van Gorcum, 1977.
10.
KnuffTEBenjaminSBCastellDO. Pharyngoesophageal (Zenker's) diverticulum: A reappraisal. Gastroenterology1982; 82: 734–6.
11.
van OverbeekJJM. Upper esophageal sphincterotomy in dysphagic patients with and without a diverticulum. Dysphagia1991; 6: 228–34.
BoydDPAdamsMD. Esophageal diverticula. N Engl J Med1961; 264: 641–5.
14.
van OverbeekJJM. Meditation on the pathogenesis of hypopharyngeal (Zenker's) diverticulum and a report of endoscopic treatment in 545 patients. Ann Otol Rhinol Laryngol1994; 103: 178–85.
15.
PayneWS. The treatment of pharyngoesophageal diverticulum: The simple and complex. Hepatogastroenterology1992; 39: 109–14.
16.
WestrinKMErgünSCarlsööB. Zenker's diverticulum — A historical review and trends in therapy. Acta Otolaryngol (Stockh)1996; 116: 351–60.
17.
PayneWSPairoleroPCPiehlerJM. The management of Zenker's diverticulum: Diverticulectomy. In: KittleCF, ed. Current controversies in thoracic surgery. Philadelphia, Pa: Saunders, 1986: 3–9.
18.
SeiffertA. Zur Behandlung beginnender Hypopharynxdivertikel. Z Laryngol Rhinol Otol1932; 23: 256–8.
19.
EllisFHJrSchlegelJFLynchVPPayneWS. Cricopharyngeal myotomy for pharyngo-esophageal diverticulum. Ann Surg1969; 170: 340–9.
20.
SchubelJ. Beitrag zur operativen Behandlung der Hypopharynxdivertikel vom Hypopharynxlumen aus. Zentralbl Chir1947; 9: 941–6.
21.
DohlmanG. Endoscopic operations for hypopharyngeal diverticula. Proceedings of the Fourth International Congress of Otolaryngology, London, 1949: 715–7.
22.
DohlmanGMattssonO. The endoscopic operation for hypopharyngeal diverticula. Arch Otolaryngol1960; 71: 744–52.
23.
van OverbeekJJMHoeksemaPEEdensET. Microendoscopic surgery of the hypopharyngeal diverticulum using electrocoagulation or carbon dioxide laser. Ann Otol Rhinol Laryngol1984; 93: 34–6.
24.
MortonRPBartleyJRF. Inversion of Zenker's diverticulum: The preferred option. Head Neck1993; 15: 253–6.
25.
EllisFH. The management of Zenker's diverticulum: Cricopharyngeal myotomy. In: KittleCF, ed. Current controversies in thoracic surgery. Philadelphia, Pa: Saunders, 1986: 10–4.
26.
van OverbeekJJMBetlemHC. Cricopharyngeal myotomy in pharyngeal paralysis. Cineradiographic and manometric indications. Ann Otol Rhinol Laryngol1979; 88: 596–602.
27.
BelseyR. Functional disease of the esophagus. J Thorac Cardiovasc Surg1966; 52: 164–88.
28.
LittleAGSkinnerDB. The management of Zenker's diverticulum: Cricopharyngeal myotomy and diverticulopexy. In: KittleCF, ed. Current controversies in thoracic surgery. Philadelphia, Pa: Saunders, 1986: 15–20.
29.
MosherHP. Webs and pouches of the oesophagus, their diagnosis and treatment. Surg Gynecol Obstet1917; 25: 175–87.
30.
SchubelJ. Ueber Erfahrungen mit der endoscopischen Methode der Swellendurchtrennung der Hypopharynxdivertikel. HNO1948; 1: 123–5.
31.
LeglerU. Untersuchungen vor und nach endoscopischer Operation kleiner und grosser Hypopharynxdivertikel. Arch Klin Exp Ohren Nasen Kehlkopfheilkd1952; 160: 547–60.
32.
LeglerU. Le traitement endoscopique du diverticule oesophago-pharyngien (Zenker). JFORL J Fr Otorhinolaryngol Audiophonol Chir Maxillofac1972; 21: 775–6.
33.
HolingerPHJohnstonKC. Endoscopic surgery of Zenker's diverticula. Experience with the Dohlman technique. Ann Otol Rhinol Laryngol1961; 70: 1117–23.
34.
HolingerPHSchildJA. The Zenker's (hypopharyngeal) diverticulum. Ann Otol Rhinol Laryngol1969; 78: 679–88.
35.
HolingerPHJensikRJ. Halting the progress of Zenker's diverticula. Geriatrics1973; 28: 133–7.
36.
TribleWM. The surgical treatment of Zenker's diverticulum: Endoscopic vs external operation. South Med J1975; 68: 1260–2.
37.
HoeksemaPEvan OverbeekJJM. Endoscopic treatment of the hypopharyngeal diverticulum. Endoscopy1978; 10: 236.
38.
van OverbeekJJMHoeksemaPE. Endoscopic treatment of the hypopharyngeal diverticulum: 211 cases. Laryngoscope1982; 92: 88–91.
39.
MulderCJJden HartogGRobijnRJThiesJE. Flexible endoscopic treatment of Zenker's diverticulum: A new approach. Endoscopy1995; 27: 438–42.
40.
HolingerLDBenjaminBNP. New endoscope for (laser) endoscopic diverticulotomy. Ann Otol Rhinol Laryngol1987; 96: 658–60.
41.
BenjaminBNPGallagherR. Microendoscopic laser diverticulotomy for hypopharyngeal diverticulum. Ann Otol Rhinol Laryngol1993; 102: 675–9.
NarneSCutroneCBonavinaLChellaBPeracchiaA. Endoscopic diverticulotomy for the treatment of Zenker's diverticulum: Results in 102 patients with staple-assisted endoscopy. Ann Otol Rhinol Laryngol1999; 108: 810–5.
48.
ScherRLRichtsmeierWJ. Endoscopic staple-assisted esophagodiverticulostomy for Zenker's diverticulum. Laryngoscope1996; 106: 951–6.
49.
ScherRLRichtsmeierWJ. Long-term experience with endoscopic staple-assisted esophagodiverticulostomy for Zenker's diverticulum. Laryngoscope1998; 108: 200–5.
50.
PhilippsenLPWeisbergerECWhitemanTSSchmidtJL. Endoscopic stapled diverticulotomy: Treatment of choice for Zenker's diverticulum. Laryngoscope2000; 110: 1283–6.
