Endoscopic treatment of Zenker diverticulum

Zenker diverticulum (ZD) is uncommon and is an outpouching of the mucosa through the Killian triangle. The basis of formation and symptomatology of ZD is believed to be because of the dysfunction of the cricopharyngeal muscle. Treatment is indicated when symptoms of dysphagia occur as progressive disease can lead to life-threatening aspiration. Treatment has evolved from surgical diverticulectomy and diverticulopexy with myotomy to myotomy alone using rigid or flexible endoscopes. Flexible endoscopic therapy is becoming more accepted, though no standardized approach exists to expose the septum (cricopharyngeus muscle) between the esophageal lumen and the ZD, the method(s) used to cut the muscle and periprocedural management. Adverse events of flexible endoscopic therapy include perforation, bleeding, and aspiration.