Endoscopic Management of Esophageal Diverticula
Summary
Esophageal diverticula are mucosal outpouchings that may occur at various levels along the oesophagus and present with dysphagia, regurgitation and risk of aspiration. They are classified anatomically as pharyngeal (Zenker’s), mid-oesophageal and epiphrenic diverticula. Traditional management has relied on open transcervical or transthoracic surgery with myotomy and, where necessary, anti-reflux procedures. However, evolving endoscopic techniques now offer less invasive alternatives. Flexible endoscopic septum division (FESD) involves direct incision of the diverticular septum to create a common cavity with the oesophageal lumen. Third-space endoscopy has given rise to peroral endoscopic myotomy approaches, notably Z-POEM and peroral endoscopic septotomy (POES), which allow submucosal tunnelling and division of the cricopharyngeal muscle under direct vision. Hybrid techniques combine septal division with tunnelling-free methods or incorporate diverticulotomy devices. These methods demonstrate high technical and clinical success rates, reduced hospital stay and rapid symptom relief, though complication profiles such as bleeding, mediastinal emphysema and perforation require careful management. Patient selection, precise pre-procedural imaging and standardisation of outcome measures remain crucial for optimising safety and efficacy.
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Endoscopic Management of Esophageal Diverticula publication trend
The graph below shows the total number of articles in endoscopic management of esophageal diverticula across all publications each year (not limited to Nature Index journals).
Technical terms
Flexible endoscopic septum division (FESD): A technique whereby the shared wall between an oesophageal diverticulum and the lumen is incised endoscopically to unify the two cavities.
Peroral endoscopic myotomy (POEM): A third-space endoscopic procedure creating a submucosal tunnel to access and divide the muscular layer, reducing intraluminal pressure.
Submucosal tunnelling: The creation of a passage between mucosal and muscular layers of the oesophagus to facilitate safe myotomy.
References
- The Endoscopic Management of Zenker’s Diverticulum: A Comprehensive Review. Diagnostics (2024).
- Peroral Endoscopic Myotomy in the Management of Zenker’s Diverticulum: A Retrospective Multicenter Study. Journal of Clinical Medicine (2021).
- Zenker’s Diverticulum: Can Protocolised Measurements with Barium SWALLOW Predict Severity and Treatment Outcomes? The “Zen-Rad” Study. Dysphagia (2020).
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