Flexible endoscopy achieves better outcomes than rigid endoscopy for Zenker diverticulum repair, making it a strong first-line option.

• Clinical success rates: flexible endoscopy 84.6% vs. rigid endoscopy 55.6% (p = 0.032); comparable to open surgery 88.9% (p = 0.712).
• Adverse event rates are lowest for flexible endoscopy at 4.5%, with a trend towards fewer complications overall.

Consider shifting to flexible endoscopy to improve patient outcomes and reduce hospital stays—0 days compared to 1 and 3 days for rigid and open surgery, respectively.