Supplementary Material for: Long-Term Outcomes of Zenker's Diverticula Treatment: Invasive Procedures Ensure Sustained Quality of Life Despite Higher Short-Term Morbidity

Introduction There is a lack of sufficient evidence-based data to support personalized treatment decisions for Zenker’s diverticulum. This study evaluates not only short-term outcomes of different treatment approaches but also identifies prognostic factors for long-term recurrence-free survival and quality-of-life. Methods We retrospectively analyzed all patients diagnosed with Zenker’s diverticulum at our center between 2001 and 2021. Long-term follow-up data, including validated quality-of-life scores (EAT-10 and GIQLI), were evaluated. Results Overall, 97 patients underwent open surgery (OS), 37 received endoscopic surgery (ES), and 17 patients were treated conservatively. Treatment-related morbidity was 25% for OS, 5% for ES, and nil for conservative management (p=0.004). After a median follow-up of 107 months, patients treated with OS or ES experienced less dysphagia (p<0.001) and regurgitation (p<0.001) compared to initial presentation. ES patients had a more favorable quality-of-life score than those treated conservatively (GIQLI: 125 vs. 106; p=0.010 but not EAT-10: 2 vs. 6; p=0.207). Recurrence rates were 28% for OS, 62% for ES, and 65% for conservative treatment (p<0.001). OS was identified as an independent prognostic factor for improved recurrence-free survival. Conclusion Despite higher short-term morbidity, OS was associated with the best recurrence-free survival. Long-term symptoms and quality-of-life outcomes were favorable and comparable between OS and ES.