Esophageal diverticulum: New perspectives in the era of minimally invasive endoscopic treatment

Table 1 Summary of the characteristics of epiphrenic and Zenker’s diverticula and their treatment options

Diverticulum	Characteristics	Treatment
Epiphrenic diverticulum	The right wall of the distal esophagus is the most common site. Pulsion-type pseudodiverticulum. Generally detected after middle-age. No difference in incidence between the sexes. More than 75% of cases occur concomitantly with esophageal motility disorders. Symptoms: dysphagia, regurgitation, chest pain	Surgical treatment; Removal of the diverticulum with myotomy through the LES and fundoplication
		Endoscopic treatment (flexible endoscope); s-POEM (myotomy through the LES); D-POEM (POEM diverticulectomy)
Zenker’s diverticulum	Arises from Killian’s triangle in the pharyngoesophagus. Pulsion-type pseudodiverticulum. Incidence: 2 per 100000 person-years, Prevalence: 0.01%-0.11% (United States, Europe > Asia)[42,43]. Common in the 7th-8th decade, male predominance[44]. Symptoms: dysphagia, regurgitation	Surgical treatment; Transcervical diverticulectomy, diverticuloplexy, or diverticular inversion.
		Diverticulectomy with rigid endoscope; Harmonic scalpel, CO2 laser, endostapler, etc.
		Diverticulectomy with flexible endoscope
		Clutch Cutter, Stag Beetle knife, D-POEM, etc.

LES: Lower esophageal sphincter; POEM: Peroral endoscopic myotomy; s-POEM: Salvage peroral endoscopic myotomy; D-POEM: Diverticular peroral endoscopic myotomy.