Zenker diverticulum

diverticulum is at approximately the level of the C5-C6 vertebrae. 

The Zenker diverticulum is not a true diverticulum as it represents only the mucosal layer and submucosa being pulled through the weakened area in the pharyngeal constrictors just above the level of the cricopharyngeus. There is no muscularis layer as would be seen in a true diverticulum and the absence of a muscular layer of the diverticulum is another reason why barium fails to empty from the pouch during barium swallow.
Diverticulectomy can be performed endoscopically or surgically with excellent outcomes achieved with both approaches.

question

what is the treatment of this lesion?
Accurate esophageal cancer staging is important, as appropriate treatment and patient outcome are stage-dependent. Detection of distant metastases is performed with radiology imaging studies. For locoregional T staging, EUS is superior to CT with overall approximate 80-90% accuracy. Patients with T2-T4 cancers cannot be treated endoscopically and typically need a combination of chemoradiation and surgery. T1 cancers are grouped into T1m involving the mucosa and/or deep mucosa or muscularis mucosa and T1sm involving the submucosa, as seen on this patient’s EUS image. T1sm tumors have a 10-30% probability of regional lymph node metastases and should be resected surgically. Only T1m or intramucosal cancers may be treated with endoscopic mucosal resection. Endoscopic radiofrequency ablation may be used to treat Barrett’s esophagus with low-grade dysplasia and/or high-grade dysplasia, but is not indicated for treatment of cancers.

images 1

ERCP and stones.

Carolis disease

PSC

cholangiocarcinoma