Diverticules de l'œsophage

Pharyngo-oesophageal diverticulum, also called Zenker's diverticulum, is the most frequent of the oesophageal diverticula. It is a hernia of the pharyngeal mucosa through the muscular layer of the pharyngo-oesophageal junction. It results from a defect in the opening of the cricopharyngeus muscle. The most common symptoms are dysphagia, regurgitations and less often pulmonary manifestations such as cough and pulmonary infections. Barium swallow helps to establish the diagnosis. The treatment is either surgical consisting of a diverticulectomy with a myotomy of the cricopharyngeus muscle, or it is endoscopic, consisting in stappled diverticulostomy. Diverticula of the mid and low oesophagus are hernias of oesophageal mucosa through the muscular layer of the oesophagus resulting from underlying motility disorders. Most of them give few or no symptoms. Existing symptoms are dysphagia, regurgitations, pulmonary manifestations or pyrosis. Barium swallow is used for establishing the diagnosis. Treatment is surgical. It is associated with a high rate of morbidity and post operative mortality, with an uncertain functional result. Consequently such diverticula should be surgically treated only if very symptomatic. Usual approach consists of diverticulectomy with myotomy of the lower oesophagus. No study has evidenced the best surgical approach yet. In the future, “mini-invasive” techniques could become the reference technique for treatment of epiphrenic diverticula.