Nel corso delle ultime decadi la gestione del diverticolo di Zenker ha subito una notevole evoluzione. Il trattamento è indicato per i pazienti sintomatici e, considerando le recenti acquisizioni sulla eziopatogenesi, sottende la miotomia chirurgica o endoscopica del muscolo cricofaringeo. Sintomi prevalenti di presentazione sono la disfagia ed il rigurgito. Colpisce prevalentemente pazienti di età medio-avanzata. Il diverticolo di Zenker è il più frequente tra i diverticoli del tratto gastrointestinale superiore con prevalenza compresa tra 0,1 e 0,11%.
Il diverticolo di Zenker è una estroflessione sacciforme della mucosa e sottomucosa che si sviluppa a livello della parete posteriore della giunzione faringoesofagea attraverso il triangolo di Killian. Based on retrospective literature results, appropriate technique selection dictated by the size of the diverticulum and the patient's conditions is however desirable. The choice between the different approaches depends on local expertise and preferences.
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The literature is mainly based on retrospective case series or comparative case series, and the optimal treatment modality has not yet been established. Endoscopic stapled diverticulotomy is generally the preferred approach, but flexible endoscopy is a valuable option, particularly for high-risk patients. In recent years, endoscopic repair of Zenker's diverticulum has been found to be a viable safe and effective alternative to surgery and gained widespread acceptance. Since Zenker's diverticulum mainly affects frail elderly patients, less invasive treatments are indicated. Open surgery with cricopharyngeal myotomy has long been the conventional treatment with satisfactory results, but is associated with high complication rates. Management of Zenker's diverticulum has dramatically progressed during past decades. Myotomy may be pursued through either open surgical or endoscopic techniques. Treatment is recommended for symptomatic patients and considering the aetiopathogenesis of the disease demands myotomy of the cricopharyngeal muscle. Predominant symptoms are dysphagia and regurgitation. It is the most common type of oesophageal diverticula with a reported prevalence ranging between 0.01 to 0.11% and typically occurs in middle-aged and elderly patients. Zenker's diverticulum is an acquired sac-like outpouching of the mucosa and submucosa layers located dorsally at the pharyngoesophageal junction through Killian's dehiscence.
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