Zenker’s Diverticulum: Transoral Repair

Zenker’s diverticulum (ZD) is a rare acquired outpouching of esophageal mucosa that typically occurs during the 7th or 8th decade of life. The outpouching is associated with halitosis, dysphagia, and aspiration. The traditional approach to repair has been via cervical dissection with myotomy and excision of the diverticulum. Alternatively, both rigid and flexible endoscopic transoral approaches have been available for more than 20 years with demonstrated comparable efficacy and safety. Data to guide technique selection is currently limited to retrospective observational and case-control studies demonstrating a slight advantage in safety profile to favor use of transoral techniques; however, there are no randomized controlled trials comparing techniques. The requirement of specialized flexible endoscopic training has limited adoption of the flexible endoscopic technique in the surgical community. Appropriate technique selection should be based on local expertise, patient characteristics, and ZD characteristics.