The patient is positioned supine on the operating room table, often with a shoulder roll to facilitate neck extension. Numerous publications report performed exible endo­scopic treatment of hypopharyngeal diverticulum under conscious sedation or moni­tored anesthesia care/deep sedation. While this in an option, we prefer intubation and general anesthesia, in case an open approach is needed. Moreover, as scope stability is the most challenging aspect of this approach, general anesthesia, and resultant mini­mal patient movement may make the procedure more facile. We would recommend a general anesthetic approach in particular for providers that have less experience with the exible endoscopic techniques, as prolonged procedure times may not be well tolerated by less sedate patients. A standard gastroscope is used, tted with a transpar­ent cap, which helps to maintain visualization of the tissue. A diagnostic endoscopy is performed rst. We typically place a nasogastric tube into the true esophageal lumen under endoscopic guidance; a guidewire may be used for the same purpose. This helps to maintain orientation and may aid in scope stability as well. While there are numer­ous reports of using a exible diverticuloscope, or modied overtube, we do not prefer this approach. The main benet of the exible diverticuloscope is scope stabilization, but we often nd the resultant limitation in scope mobility to be detrimental. Any bezoar is removed from the diverticulum. We prefer to use a triangular tip knife for the procedure. A cut current is used to divide the mucosa and a coagulation current there­after. The triangular tip knife is larger than most other endoscopic knives, so caution must be exercised as thermal spread can also be greater. However, the increased sur­face area allows the knife to be used to push bers or edges away, and the corners may be used to pull bers as well; the multiple ways to use the knife may be advantageous in the small space.