Pharyngeal pouch (Zenker's diverticulum)

Pharyngeal pouches occur most commonly in elderly patients (over 70 years) and typical symptoms include dysphagia, regurgitation, chronic cough, aspir ation, and weight loss. The aetiology remains unknown but theories centre u pon a structural or physiological abnormality of the cricopharyngeus. A dia gnosis is easily established on barium studies. Treatment is surgical via a n endoscopic or external cervical approach and should include a cricopharyn geal myotomy. Unfortunately pharyngeal pouch surgery has long been associat ed with significant morbidity, partly due to the surgery itself and also to the fact that the majority of patients are elderly and often have general medical problems. External approaches are associated with higher complicati on rates than endoscopic procedures. Recently, treatment by endoscopic stap ling diverticulotomy has becoming increasingly popular as it has distinct a dvantages, although long term results are not yet available. The small risk of developing carcinoma within a pouch that is not excised remains a conte ntious issue and is an argument for long term follow up or treating the con dition by external excision, particularly in younger patients.