What is the treatment approach for Zenker's diverticulum greater than 2 cm?

In the case of Zenker's diverticulum, which is a pharyngeal pouch that occurs due to weakness in the esophageal wall, treatment options depend on the size of the diverticulum and the symptoms experienced by the patient. For diverticula larger than 2 cm, surgical intervention is typically recommended.

Diverticulectomy and cricopharyngeal myotomy is the preferred treatment approach in these cases. The procedure involves surgically removing the diverticulum and cutting the cricopharyngeal muscle to alleviate any obstruction and allow for better swallowing function. This surgical intervention helps to resolve symptoms such as dysphagia (difficulty swallowing) and can prevent complications such as aspiration and chronic cough.

In contrast, watchful waiting might be appropriate for smaller diverticula or asymptomatic cases, while medication for heartburn would not address the mechanical issues caused by the diverticulum. Endoscopic balloon dilation can be effective for some patients, particularly those with smaller diverticula or specific complications, but for diverticula larger than 2 cm, diverticulectomy combined with myotomy is favored due to its potential for more definitive relief of symptoms and reducing the risk of complications.