Key Points

• Esophageal diverticula may be classified by presumed pathophysiology (traction versus pulsion), type (true versus false), or esophageal location.
• Zenker’s diverticulum is seen most often in the elderly, and other esophageal pathologic processes are common.
• Association between gastroesophageal reflux disease and Zenker’s diverticulum is well known but may not be a cause-and-effect.
• Diverticula of the esophageal body are infrequent and are found most often in an epiphrenic location.
• Principle of treatment is relief of distal obstruction by myotomy. The diverticulum then must be excised or suspended, or in the case of trans oral, the diverticulum is “incorporated” into the lumen.
• Treatment may be by “classic” open surgery or by endoscopic or minimally invasive techniques.

Diverticula of the esophagus are classified as either traction or pulsion diverticula. Traction diverticula are true diverticula caused by a mediastinal inflammatory process (e.g., tuberculosis). Clinically significant, large traction diverticulae are rare, smaller ones are often asymptomatic, and not associated with any motility disorders. Specific treatment is usually not necessary. Pulsion diverticula are false diverticula, because only mucosa and submucosa protrude through the muscle fibers of the esophageal wall. It is now accepted that in the majority of cases they are the expression of an underlying motility disorder. Pulsion diverticula are seen at the level of pharyngoesophageal junction (Zenker’s diverticulum) and in the middle and distal (epiphrenic) portions of the esophagus. The clinical presentation and the treatment of these pulsion diverticula are reviewed here.