Guideline sources The following summarized guidelines for the evaluation and management of zenker's diverticulum (ZD) are prepared by our editorial team based on guidelines from the European Society of Gastrointestinal Endoscopy (ESGE 2020). 1 Guidelines 1. Diagnostic investigations Barium esophagram: obtain barium swallow radiography with videofluoroscopy for the evaluation of patients with (suspected) ZD. B Esophageal manometry: avoid obtaining manometry in the diagnostic evaluation of patients with ZD. D 2. Perioperative care Perioperative antibiotic prophylaxis: do not administer routine prophylactic antibiotics before or after endoscopic septotomy for ZD. D 3. Surgical interventions https://web.pathway.md/diseases/recnZSmhYX9PACOdp 1/2 6/29/23, 3:10 AM Zenker's diverticulum Pathway Endoscopic surgery: consider performing flexible endoscopic treatment over open surgical treatment as first-line therapy in patients with a symptomatic ZD of any size. C Show 6 more 4. Follow-up and surveillance Management of recurrent disease: consider performing flexible endoscopic treatment for the management of patients with recurrent ZD. C Clinical findings Symptoms Past medical history Chest pain GERD Cough Hiatal hernia Dysphagia Recurrent pneumonia Food regurgitation Halitosis Heartburn Noisy swallowing Weight loss Imaging findings Pharyngeal pouch References 1. Bas L A M Weusten, Maximilien Barret, Albert J Bredenoord et al. Endoscopic management of gastrointestinal motility disorders - part 2 European Society of Gastrointestinal Endoscopy ESGE Guideline. Endoscopy. 2020 Jul;52 7 600 614. Open https://web.pathway.md/diseases/recnZSmhYX9PACOdp 2/2