Ms. Quynh, 36, sought medical attention for persistent bad breath and a sensation of food getting stuck when swallowing. An endoscopy revealed a Zenker's diverticulum in the upper one-third of her esophagus, alongside moderate gastric mucosal hyperemia. Doctor Do Minh Hung, Director of the Endoscopy and Gastrointestinal Endoscopic Surgery Center at Tam Anh General Hospital in Ho Chi Minh City, explained that a Zenker's diverticulum is a "false diverticulum." It consists only of the mucosal and submucosal layers protruding through a weak point in the esophageal muscle layer, unlike a true diverticulum which includes all layers of the esophageal wall.

This condition affects approximately 10 to 110 people per 100,000. While mostly benign, it can lead to serious complications if left untreated. The diverticulum creates a pouch where food and saliva can easily accumulate after swallowing. Over time, this trapped food decomposes and ferments, leading to persistent bad breath. Patients also often experience a feeling of obstruction, choking, or coughing after eating.

Following a consultation, doctors recommended treatment using the Z-POEM (Zenker's Peroral Endoscopic Myotomy) technique. This modern, minimally invasive endoscopic procedure is performed entirely through the mouth with a flexible endoscope, eliminating the need for an incision in the neck.

According to doctor Hung, compared to open surgery or traditional endoscopic surgery, Z-POEM is less invasive, results in less postoperative pain, leaves no scars, reduces complications, and promotes faster patient recovery.

Doctor Do Minh Hung (far right) performs an endoscopic diverticulectomy on Ms. Quynh. Photo: Tam Anh General Hospital

The medical team lifted the mucosal layer between the esophagus and the diverticulum to create a submucosal space, then made a small incision to insert the endoscope. Doctors dissected the muscle layer between the esophagus and the diverticulum and cut the obstructive muscle in the esophageal neck region. This re-established proper flow between the diverticulum lumen and the esophagus, reducing food stagnation. After the intervention, the mucosal incision was closed with specialized metal clips, which detach naturally once the tissue heals. Post-surgery, Ms. Quynh experienced almost no pain and was discharged after one day.

A nurse cares for Ms. Quynh after the procedure. Photo: Tam Anh General Hospital

Doctor Hung explained that the main cause of Zenker's diverticulum is related to a functional disorder of the cricopharyngeal muscle, part of the upper esophageal sphincter. In a healthy individual, this muscle relaxes synchronously during swallowing, allowing food to pass from the pharynx into the esophagus. However, when this muscle loses its coordinated function, pressure in the pharyngeal region increases with each swallow. Over time, this sustained pressure pushes the mucosal lining outward, forming the diverticulum.

The condition is more common in older men. Treatment approach varies depending on the diverticulum's size and symptoms. Small diverticula with few symptoms may be managed with regular monitoring and dietary adjustments. Conversely, large diverticula causing severe difficulty swallowing, choking, aspiration pneumonia, or significantly impacting quality of life require early intervention to prevent complications.

Doctors advise individuals experiencing persistent difficulty swallowing, chronic bad breath, or frequent choking or coughing after eating to seek early consultation with a gastroenterologist for timely diagnosis and treatment.

Quyen Phan