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ERCP endoscope cannot be introduced into esophagus - diverticulum?
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The patient developed ascending cholangitis due to a biliary calculus in the distal common bile duct (CBD). The ERCP endoscope could not be introduced into the esophagus, nor a more slender gastroscope. This was explained by the identification of a Zenker diverticulum at fluoroscopy.
Zenker diverticulum is a pulsion diverticulum, meaning that it is caused by raised pressure in the esophagus, attributed to cricopharyngeal spasm. It is actually a pseudodiverticulum, meaning that the mucosa and submucosa bulge out through the muscularis propria.
Treatment of Zenker diverticulum consists mainly of cricopharyngeal myomectomy and resection of the diverticulum.