Zenker's diverticulum classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ajay Gade MD[2]]

Overview

Diverticula of the esophagus can be classified into phrenoesophageal (Zenker's diverticulum-70%), epiphrenic, thoracic and mediastinal.

Classification

• Esophageal diverticula are classified on the basis of location into three types

• Almost all esophageal diverticula are acquired pulsion diverticula.

1. Phrenoesophageal (Zenker's diverticulum-70%)

• ZD is a defect over the Killian's triangle, a point of weakness in the muscular wall of the hypopharynx

2. Epiphrenic (20%)

• Epinephric diverticula result either from hypertonia of the lower esophageal sphincter (esophageal achalasia)

3. Thoracic and mediastinal (10%)

• Thoracic diverticula are probably more often of a congenital than traction origin.

Type of diverticulum	Major characteristics
Zenker's diverticulum	Defect over Killian's triangle Weakness in the muscular wass of hypopharynx
Traction diverticulumm	Small Mid-esophagus Motor disorder or post-inflammatory
Epiphrenic diverticiulum	Above lower esophageal sphincter Background of a motility disorder such as achlasia or diffuse esophageal spasm Nocturnal regurgitation of fluids
Thoracic diverticulum	Rare (10 % of esophageal diverticula) Dysphagia and regurgitation Due to congenital reasons, traction, pulsion and neuromuscular incoordination (functional) Epibronchial variety most common
Mediastinal diverticulum	Most commonly secondary to traction (for example from calcified lymph nodes after tuberculosis)