What is the typical treatment for Zenker's diverticulum?

• A. Endoscopic stapled diverticulostomy or cricopharyngeal myotomy; open surgery in selected cases.
• B. Proton pump inhibitors and dietary modification only.
• C. Balloon dilation of the diverticulum.
• D. Antibiotics and observation.

Answer: (A)

Zenker's diverticulum is best treated by addressing the dysfunctional upper esophageal sphincter and the diverticular pouch itself. The typical approach is an endoscopic stapled diverticulostomy or cricopharyngeal myotomy, which opens a passage between the esophagus and the diverticulum and relaxes the cricopharyngeus. This relieves the outflow obstruction that allowed the pouch to form, reduces regurgitation and aspiration risk, and is less invasive than open surgery. Open surgery is reserved for selected cases, such as very large or complicated diverticula or when endoscopic methods aren’t suitable.

Proton pump inhibitors and dietary modification don’t correct the structural issue or prevent regurgitation. Balloon dilation targets the muscle but doesn’t remove the diverticular sac, and it may not prevent recurrence. Antibiotics and observation fail to address the underlying problem and would not prevent potential complications like aspiration.