Treatment of Symptomatic Zenker's Diverticulum or Zenker's (Hypopharyngeal) Diverticulum Larger Than 1 cm

This protocol covers the clinical management of Zenker's diverticulum in patients who are symptomatic or have a pouch exceeding 1 cm — the point at which active intervention is appropriate.

Clinical scenario

Symptomatic Zenker's diverticulum, or a Zenker's (hypopharyngeal) diverticulum larger than 1 cm. Treatment decisions in this population depend on local expertise and the technical feasibility of procedures, which are influenced by the patient's anatomy.

Treatment approach

Endoscopic intervention is the primary framework for managing eligible patients, with the specific technique determined by clinical and anatomical considerations. The full procedural options and selection criteria are detailed in the complete protocol.

Clinical goal: Relief of Zenker's diverticulum symptoms — principally dysphagia and regurgitation.

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References

For patients with symptomatic ZD or diverticula larger than 1 cm, treatment decisions depend on local expertise and the technical feasibility of procedures, which are influenced by the patient's anatomy.
Treatment approaches include open surgery, such as cricopharyngeal myotomy with diverticulectomy or diverticulopexy, and endoscopic methods, including rigid endoscopic stapling, flexible endoscopic septotomy, Z-POEM, and dilation.
Endoscopic techniques, particularly stapler-assisted oesophagodiverticulostomy, have become the first-line treatment for moderate-sized diverticula (3–5 cm).
The success rate is high, with symptom relief in approximately 90% of cases.

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