Zenker's diverticulum from pathophysiology to novel therapeutic approaches

Zenker's diverticulum is an outpouching of mucosa and submucosa through the Killian triangle that is believed to be caused by dysfunction of the cricopharyngeal muscle. It is a relatively uncommon disorder occurring in the elderly. The predominant symptom is dysphagia but serious complications as chronic aspiration and recurrent pneumonia can occur. Videofluoroscopy confirms the diagnosis. An interventional therapy approach is necessary only in symptomatic diverticula and has evolved from an open surgical approach to less invasive techniques transoral endoscopic techniques. Nowadays, minimally invasive techniques are the mainstay for the treatment as they offer comparable success rates with fewer and less serious complications, but not every diverticulum can be treated with this approach. Tailored surgery should be planned taking account of the patient symptoms and comorbidities and the anatomical features of the diverticulum.