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Treatment of Zenker’s diverticulum in a tertiary hospital: our experience
Poster Abstract

Background

Flexible endoscopy has emerged as a minimally invasive alternative to open surgery and rigid endoscopy for the management of Zenker’s diverticulum. Among flexible endoscopic approaches, the most widely used are flexible endoscopic septotomy (FES) and peroral endoscopic myotomy for Zenker’s diverticulum (Z-POEM).

Aim

To describe our experience in the treatment of Zenker’s diverticulum using flexible endoscopic septotomy (FES).

Methods

Retrospective review about clinical outcomes and technical aspects of patients treated with FES at a tertiary center between 2024 and 2025. Demographic data, procedural details, and follow-up outcomes were analyzed.

Results

Five patients (4 men) aged 58–86 years with Zenker’s diverticulum measuring 20–50 mm were included. The main clinical presentations were oropharyngeal dysphagia (4 patients) and recurrent aspiration pneumonia (1 patient). Diagnosis was established by gastroscopy, barium swallow, and computed tomography.

The procedure was performed under deep sedation in 4 patients and general anesthesia in 1. A flexible diverticuloscope was used in 80% of cases and a transparent cap in 20%, this one in patients with smaller diverticulum. FES was carried out using a Stag Beetle dissection knife, sectioning the septal muscular fibers while maintaining a 5–8 mm safety margin. The mucosal incision was closed with 3–4 through-the-scope clips in all patients.

No intraprocedural or postprocedural complications occurred. The mean hospital stay was 1 day. At one-month follow-up, all patients reported significant symptomatic improvement (Eckardt score 0–1). At 6–8 months, control esophagography revealed a small residual diverticulum in all cases, without clinical repercussion or need for retreatment.

Conclusions

In our experience, flexible endoscopic septotomy is an effective and safe therapeutic option for Zenker’s diverticulum, offering rapid recovery and excellent short-term outcomes. The use of a transparent cap represents a valid alternative when diverticuloscope placement is not factible due to small diverticulum size.