Zenker's diverticulum: reappraisal.

For more than 2 centuries, the nature and pathophysiology of pharyngoesophageal (Zenker's) diverticulum has been a matter of argument. The intrinsic or extrinsic forces and structures that might play a role in the development of this disorder have been repeatedly scrutinized, and still today the different theories of muscular incoordination and/or spasm, cricopharyngeal achalasia, gastroesophageal reflux, or neuromuscular abnormalities try to find their way as the final word regarding etiology remains to be told. Options for treatment follow a similar pattern although myotomy and diverticulopexy seem to have yielded the best results. In this review, historical and current data gathered from the world literature are compiled in an attempt to give a clear overview of the pathophysiology surrounding the genesis of Zenker's diverticulum and the clinical manifestations, diagnosis, and different alternatives for definite treatment of this disorder.