An esophageal diverticulum is an abnormal pouch that develops in weak spots in your esophageal lining and pushes outward through the muscle wall of your esophagus. Your esophagus is the tube that carries food from your mouth to your stomach.

Esophageal diverticula can occur anywhere along the length of your esophagus. They are classified according to where they are located:

• Zenker’s diverticula – the most common form of esophageal diverticula. Zenker’s diverticula are typically found in the back of your throat, just above the esophagus.
• Midthoracic diverticula – the pouch is located in the middle portion of your esophagus.
• Epiphrenic diverticula – the pouch is located in the bottom of your esophagus, just above your diaphragm.

Symptoms of Esophageal Diverticulum

An esophageal diverticulum does not always cause symptoms but when it does, they may include:

• Difficulty swallowing (dysphagia)
• Bad breath
• Regurgitation of food
• Chest pain
• Heartburn
• Chronic cough

Causes of Esophageal Diverticulum

Esophageal diverticulum can be congenital, which means you have it when you are born, or acquired, which typically happens more often when you are over 60. If you have the acquired form, it may stem from a motility disorder like achalasia or from a swallowing disorder.

Diagnosing Esophageal Diverticulum

Tests and procedures to diagnose GERD include:

• Physical exam
• Barium swallow – X-rays of your digestive tract are taken after you drink a solution containing barium.
• Upper endoscopy (EGD) – a test to examine the lining of your esophagus, stomach and the first part of your small intestine.
• Esophageal manometry – a test to measure the muscle contractions of your esophagus.
• Chest X-ray
• CT Scan 

Treating Esophageal Diverticulum

You do not always need treatment for esophageal diverticulum. If, however, the pouch in your esophagus becomes overly large or begins causing symptoms, surgery may be needed to remove the pouch and repair your esophageal wall.

The type of surgery depends on the type of diverticulum.

• Zenker’s diverticula may be treated by:
  
  • Cricopharyngeal myotomy: Surgical treatment to remove small diverticula through an open or trans oral approach.
  • Diverticulopexy with cricopharyngeal myotomy: Removing larger diverticula by turning the diverticular sac upside down and suspending it by suturing it to the esophageal wall.
    
    
• Midthoracic diverticula may be treated with a diverticulectomy and long esophageal myotomy if motility is the underlying cause. In this approach, the diverticulum is removed, and the muscle of the esophagus is opened. This can be approached minimally invasively (VATS) or robotically.
  
  
• Epiphrenic diverticula is most commonly seen in the setting of achalasia but other problems can also cause epiphrenic diverticula. 
  
  • In the setting of achalasia, the most common reason for the development of the epiphrenic diverticula is the diverticula is removed and the muscle is divided (myotomy) to relieve the high-pressure muscle downstream. This prevents recurrence and also allows food to pass more easily. This is typically approached robotically.