Diagnosis

Endoscopic diagnostic criteria

The endoscopic appearance depends on the size, location, and nature of the diverticulum (Figs. 3.47, 3.49). ► Cervical diverticulum

Early - Small mucosal protrusion, which is often overlooked (stage I) Later - Deep pouch forming a "false lumen," whose axis is perpendicular to the longitudinal axis of the esophagus (stage II) Late - Descent of the diverticular axis

- Possible anterior displacement of the esophageal axis, with displacement of the diverticular axis into the original esophageal axis (stage III) - May contain food residues

Differential diagnosis

► Typical findings

Checklist for endoscopic evaluation

► Location (in centimeters from the incisors, physiological constriction, anterior/posterior)

► With epiphrenic diverticula: Concomitant diseases? Hernia? Reflux? Achalasia?

Additional Studies

► Radiographic contrast examination

► With epiphrenic diverticula: manometry

► With thoracic diverticula: Tb testing, possibly computed tomography (CT)

- Fig. 3.48 Types of diverticula

Thyroid gland Thyropharyngeal fibers a Zenker diverticulum. The sac protrudes between the oblique thyropharyngeal fibers and transverse cricopharyngeal fibers of the constrictor pharyngis inferior muscle

Thyroid gland Thyropharyngeal fibers a Zenker diverticulum. The sac protrudes between the oblique thyropharyngeal fibers and transverse cricopharyngeal fibers of the constrictor pharyngis inferior muscle

Pharyngobasilar fascia

Constrictor pharyngis inferior muscle

Cricopharyngeal fibers Zenker diverticulum

Esophagus

Pharyngobasilar fascia

Constrictor pharyngis inferior muscle

Cricopharyngeal fibers Zenker diverticulum

Esophagus

Esophagus Trachea

Tracheobronchial lymph nodes

Right main

X^j) bronchus

Parabronchial diverticulum b Traction diverticulum

Esophagus Trachea

Tracheobronchial lymph nodes

Right main

X^j) bronchus

Parabronchial diverticulum b Traction diverticulum

CT fD

fD VJ

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