Zenker diverticulum — ESEGH MCQ

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ModerateLuminal GIZenker diverticulumESEGH

A 71-year-old woman reports intermittent dysphagia localised to the neck, halitosis, regurgitation of undigested food and nocturnal coughing. Contrast videofluoroscopy demonstrates a posterior outpouching from the hypopharynx immediately above the cricopharyngeus muscle. What is the most likely diagnosis?

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Correct answer: E — Zenker diverticulum

The diagnosis is **Zenker diverticulum**, a pulsion diverticulum arising posteriorly through the Killian triangle immediately above the cricopharyngeus. Retention of food within the pouch produces cervical dysphagia, regurgitation of undigested food, halitosis and nocturnal cough or aspiration. Contrast videofluoroscopy confirms the pouch and provides dynamic information about regurgitation and aspiration. A Killian-Jamieson diverticulum arises anterolaterally below the cricopharyngeus rather than posteriorly above it. Epiphrenic diverticula occur in the distal oesophagus, while traction diverticula are usually mid-oesophageal. Achalasia causes impaired oesophagogastric junction relaxation with distal tapering and oesophageal retention, not a posterior hypopharyngeal pouch.

Reference: European Society of Gastrointestinal Endoscopy. Endoscopic management of gastrointestinal motility disorders – part 2: ESGE Guideline, section 3.1, 2020. https://www.esge.com/assets/downloads/pdfs/guidelines/2020_a_1171_3174.pdf