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BACKGROUND AND STUDY AIMS: The increasing use of flexible endoscopy to treat symptomatic Zenker's diverticulum is only partially supported by data on safety and benefits. This retrospective study reports the mid-term results of argon plasma coagulation (APC) for flexible endoscopic therapy of Zenker's diverticulum. PATIENTS AND METHODS: Between January 2002 and July 2006, 41 patients (27 men, 14 women, mean age ? standard deviation [SD] 73 ? 11 years) were treated by means of APC flexible endoscopic Zenker's diverticulotomy. Technical and immediate clinical success (on a 3-month control examination) was assessed for the entire group. Mid-term follow-up data were obtained for patients treated until December 2005 (n = 34) with a mean ? SD follow-up period of 16 ? 5 months. RESULTS: Technical success was achieved in all 41 patients, with a mean ? SD of 3 ? 2 treatment sessions during one or two hospitalizations (1 - 3 sessions for 78 % patients, > 3 sessions for 22 % patients). Immediate clinical success was achieved in 95 % of cases. Fever occurred in seven patients (17 %), lasting less than 24 hours in three patients (7 %) and associated with clinical infections in four (10 %); one perforation occurred, which was managed conservatively. In the patients for whom we had mid-term follow-up data, 5/34 experienced recurrence and achieved a successful clinical outcome after retreatment with APC. CONCLUSIONS: APC treatment of Zenker's diverticulum is safe and effective in the short term, with a mean of three treatment sessions. Recurrence rates of around 15 % have to be expected on mid-term follow-up. The relative value of APC vs. needle-knife techniques can only be clarified in a prospective randomized study. [ABSTRACT FROM AUTHOR]