Which of the following best describes a standard approach to Zenker's diverticulum management?

• A. Can be treated with either endoscopic diverticulotomy/diverticulostomy or open diverticulectomy with cricopharyngeal myotomy
• B. Must be treated with chemotherapy
• C. Cannot be treated surgically
• D. Only functional therapy without surgery is used

Answer: (A)

Zenker's diverticulum is a structural outpouching at the pharyngoesophageal (Killian) area caused by cricopharyngeal muscle dysfunction, so the aim of treatment is to relieve the obstruction and prevent regurgitation or aspiration. The standard approach is surgical, with two main options. Endoscopic diverticulotomy or diverticulostomy splits the common wall between the diverticulum and the esophagus, effectively enlarging the passage and relieving the high-pressure segment. This minimally invasive route is typically preferred for suitable-sized diverticula and offers quicker recovery. If the anatomy is not favorable for an endoscopic approach or the diverticulum is large, an open diverticulectomy with cricopharyngeal myotomy removes the pouch and directly addresses the cricopharyngeus dysfunction, though it involves a more extensive operation and longer recovery. Chemotherapy or purely functional therapy without surgery do not address the structural pouch, so they are not standard treatments.