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A videoesophagram is the most effective way to diagnose a Zenker's diverticulum. The barium used in the procedure fills the pouch, making it visible in the upper part of the esophagus, as shown in the picture below.
Upper endoscopy allows assessing the inside of the diverticulum and the size of its opening. The procedure needs to be done very carefully and by expert hands to prevent esophageal perforation.