To evaluate clinical and technical efficacy, safety profile, and recurrence rate of flexible endoscopic septotomy (FES) for Zenker's Diverticulum (ZD) in a high-volume referral center.

This retrospective single-center study included all consecutive adults undergoing FES for symptomatic ZD from January 2010 to November 2025. Clinical, endoscopic, and procedural data were collected from electronic records. Septotomy was performed using either a diverticuloscope-assisted or free-hand approach using IT-Knife 2. Clinical follow-up at 1, 6, and 12 months, and thereafter until recurrence, assessed symptom resolution using the Dakkak and Bennett score. Primary outcome was clinical success (score = 0). Secondary outcomes included technical success, recurrence and adverse events rates

A total of 55 procedures were performed in 50 patients (median age 74 years; 70% male). Median diverticulum size was 30 mm (range 25–50). Median follow-up was 84 months (range 6–144). Clinical success was achieved in 45/50 patients (90%). Five patients experienced recurrence at 8, 11, 96, 96, and 144 months; all of these underwent successful re-septotomy with no further recurrence. Technical success was achieved in all cases (100%), with a mean procedure time of 17 ± 4 minutes. Intraprocedural bleeding occurred in three patients, all managed endoscopically by clip apposing; no post-procedural or late adverse events were observed. Fourty-nine patients (98%) were discharged within 48 hours

FES is a highly effective and safe treatment for ZD, offering excellent long-term symptom-free period. Even in cases of recurrence, repeat endoscopic treatment can be is successfully and safety performed. These findings support FES as a first-line therapy, while highlighting its robust long-term performance in the era of emerging endoscopic techniques