{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T17:16:49Z","timestamp":1790011009691,"version":"4.0.1"},"reference-count":38,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2025,8,30]],"date-time":"2025-08-30T00:00:00Z","timestamp":1756512000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Zenker\u2019s diverticulum (ZD) is an esophageal condition that results in an outpouching of the mucosal layer through a weakened area in the hypopharyngeal wall. This condition can cause symptoms like dysphagia, regurgitation, and aspiration, impacting patients\u2019 quality of life. Historically, open surgery was the primary treatment. Although effective, this method is associated with longer recovery times and risks such as infections, nerve damage, and prolonged hospitalization. Rigid endoscopic stapling emerged as a less invasive alternative, offering high success rates for patients with favorable anatomy. Zenker\u2019s peroral endoscopic myotomy (Z-POEM), adapted from treatments for achalasia, represents the latest advancement in ZD management. It involves creating a submucosal tunnel and precisely dividing the cricopharyngeus muscle. Z-POEM is minimally invasive and often provides quick relief with a high success rate of around 92%, while enabling outpatient treatment or brief hospital stays. However, it requires specialized expertise, and long-term data on recurrence rates are still emerging. This review discusses the evolution of these treatment modalities through comprehensive searches of PubMed, MEDLINE, and ScienceDirect databases. Studies reporting on treatment outcomes, complication rates, operative times, and clinical success associated with open surgery, rigid endoscopic stapling, and Z-POEM were included, with emphasis on meta-analyses, multicenter studies, and large case series highlighting Z-POEM\u2019s comparable success to open surgery and increased patient tolerance. Open surgery achieves long-term symptom resolution rates of 90\u201395% but is associated with higher complication rates (up to 30%) and prolonged recovery times. Rigid endoscopic stapling offers symptom relief in approximately 90% of cases, with lower morbidity and shorter hospital stays (1\u20132 days), though anatomical limitations restrict its use. Z-POEM has demonstrated clinical success rates of 85.5\u201393%, with major complications reported in 4.8\u20135% of cases and recurrence rates as low as 1.4% at one-year follow-up in larger diverticula. Z-POEM\u2019s minimally invasive nature and suitability for high-risk patients make it increasingly preferred in specialized centers. Management of Zenker\u2019s diverticulum has evolved significantly, with endoscopic techniques, particularly Z-POEM, offering comparable success to open surgery but with fewer complications and faster recovery. Ongoing advances in endoscopic equipment and technique, along with emerging data on long-term outcomes, are likely to further refine treatment algorithms for ZD, especially for elderly and high-risk populations. Future directions in ZD management include ongoing research to enhance the safety and efficacy of endoscopic techniques, with new technologies on the horizon that could further improve outcomes and accessibility.<\/jats:p>","DOI":"10.3390\/jcm14176141","type":"journal-article","created":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T13:01:13Z","timestamp":1756818073000},"page":"6141","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Management Strategies for Zenker\u2019s Diverticulum: A Comprehensive Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-1639-4515","authenticated-orcid":false,"given":"Suhaas","family":"Ramamurthy","sequence":"first","affiliation":[{"name":"Department of Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry 605006, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6017-2563","authenticated-orcid":false,"given":"Priyanka","family":"Ahuja","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Toledo, Toledo, OH 43606, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8544-9039","authenticated-orcid":false,"given":"Dushyant Singh","family":"Dahiya","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Motility, The University of Kansas School of Medicine, Kansas City, KS 66160, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3484-1994","authenticated-orcid":false,"given":"Umar","family":"Hayat","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA 18711, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neha","family":"Ahuja","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Shaheed Mohtarma Benazir Bhutto University, Larkana 77150, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7979-2834","authenticated-orcid":false,"given":"Hareesha Rishab","family":"Bharadwaj","sequence":"additional","affiliation":[{"name":"Faculty of Biology Medicine and Health, The University of Manchester, Manchester M13 9PL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manesh Kumar","family":"Gangwani","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University of Arkansas Medical Sciences, Little Rock, AR 72205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumant","family":"Inamdar","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University of Arkansas Medical Sciences, Little Rock, AR 72205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.gie.2019.04.249","article-title":"An international study on the use of peroral endoscopic myotomy in the management of Zenker\u2019s diverticulum","volume":"91","author":"Yang","year":"2020","journal-title":"Gastrointest. 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