Clinical Insights into Zenker’s Diverticulum: Anatomy, Pathophysiology, Diagnosis, and Evolving Treatments

Background/Objectives: Zenker’s diverticulum (ZD) is a rare but clinically relevant con- dition. It is a false, pulsion-type diverticulum due to the protrusion of mucosal and submucosal layers through the Killian’s Triangle. Its pathogenesis is multifactorial and entails cricopharyngeus muscle dysfunction and age-related tissue degeneration. This review addresses the current evidence regarding the anatomy, pathophysiology, clinical presentation, diagnostic approach, and therapeutic management of ZD. Methods: For this literature review, we searched the PubMed and Scopus databases using combina- tions of keywords relevant to Zenker’s diverticulum, including “Zenker’s diverticulum,” “esophageal diverticula,” “diagnosis,” “endoscopic treatment,” and “surgery”. We in- cluded articles published in recent decades, with a focus on most recent ones regarding clinical studies, systematic reviews, meta-analyses, and descriptions of new diagnostic and therapeutic techniques. Results: Characteristic symptoms comprise progressive dyspha- gia, regurgitation of undigested food, halitosis, and, in advanced cases, aspiration-related respiratory complications. Diagnosis of ZD is primarily based on barium swallow esopha- gography and endoscopic evaluation, complemented by other imaging techniques. Current therapeutic options include traditional open surgery and endoscopic procedures, including newer minimally invasive techniques. Conclusions: ZD is the most common type of esophageal diverticulum and can have a disabling impact on a patient’s quality of life. It is commonly underdiagnosed or misdiagnosed as another condition, and prevalence is expected to increase with the growing population ageing. Improved understanding of its pathophysiology is needed to refine diagnostic and therapeutic strategies and minimize recurrences and risks.