Endoscopic management of Zenker’s diverticulum

Zenker’s diverticulum (ZD) is a pulsion-type hypopharyngeal pseudodiverticulum that develops through Killian’s triangle. The treatment of symptomatic ZD of variable sizes involves cricopharyngeal myotomy. Endoscopic techniques, particularly flexible endoscopic septotomy and Zenker’s per-oral endoscopic myotomy, have become preferred treatment options compared with traditional surgery. Both endoscopic procedures provide comparable efficacy, an acceptable adverse event profile, and promising durability. However, recurrence remains possible, and retreatment using the same modality is both feasible and safe. Given the broad range of clinical presentations and the heterogeneity in treatment response, an optimal “one size fits all” solution for symptomatic ZD is still lacking, and the most appropriate intervention will continue to depend on patient preference within the context of local expertise.