How is an esophageal diverticulum treated?
Because the individual forms of esophageal diverticulum have different causes and also occur at different sites, it is worthwhile to look at the treatment of each diverticulum separately. Therapy of traction diverticula-parabronchial diverticula: Since this form of diverticulum rarely causes symptoms and the diagnosis is usually a chance finding, treatment of esophageal diverticula is almost never necessary. However, if there are persistent complaints that are clearly attributable to the diverticulum, the therapy consists of surgical removal of the diverticulum.
Therapy of epiphrenal diverticula: At first, an attempt can be made to alleviate the symptoms (often swallowing difficulties) by various general measures. The patients are advised to change their diet. This includes that instead of the main meals, several smaller meals should be taken throughout the day.
It is also helpful if the ingested food is chewed well or has a mushy consistency per se, so that it can pass through the oesophagus more easily. Acidic foods and drinks must be avoided consistently. Sleeping with a raised upper body can prevent or at least reduce the risk of food burping up again.
A reflux disease, which can occur as a result of the epiphrenic divertic, must also be treated with medication. If, despite such behavioral therapy measures, the symptoms worsen, the esophageal diverticulum must be surgically removed. Therapy of the Zenker’s diverticulum: The treatment of Zenker’s diverticulum requires early surgical therapy, as the complications caused by it (see below) are feared and conservative therapy does not usually relieve symptoms.
Even small protrusions can be removed early. In the past, the standard surgical procedure for esophageal diverticula consisted of open diverticulectomy or diverticulopexy, in which the esophagus was exposed in the neck region. In this method, the upper esophageal muscle, which can be thickened in the case of diverticulitis, is incised (myotomy) and the diverticulum is removed (ectomy) or sutured up (pee-pee).
Complications:In 1-3% of patients a new diverticulum occurs after the operation (recurrence). In rare cases (3-5%), the recurrent nerve may also be injured. Since this nerve controls the function of the vocal cords, its injury may result in hoarseness.
A more modern therapeutic procedure for esophageal diverticula, the so-called transoral diverticulostomy, is performed endoscopically (minimally invasive). The complication-prone neck incision is not necessary. The diverticulum is removed during an oesophagoscopy using a laser and stapler. The surgical results are comparable to those of open surgery in terms of freedom from symptoms, but with a lower complication rate, faster recovery and less surgical trauma for the patient.
