INTRODUCTION: Zenker’s diverticulum (ZD) occurs mostly in elderly patients and may manifest with dysphagia, halitosis, regurgitation, and aspiration. We present a rare cause of esophageal dysphagia from an obstructing cyst on the cricopharyngeal septum within the Zenker’s diverticulum, successfully treated with endoscopic ultrasound guided drainage and endoscopic incisional therapy. CASE DESCRIPTION/METHODS: A 68-year-old female was referred for endoscopic treatment of a suspected Zenker’s diverticulum seen on esophagram. On endoscopic exam, she was found to have an obstructing Zenker’s diverticulum in the proximal esophagus with a cystic structure on the cricopharyngeal septum (image 1). Endoscopic ultrasound exam was done to characterize the cystic lesion which showed a 14 mm anechoic round cyst originating in the deep mucosa (image 2). Color Doppler did not find any significant vascular flow within the cyst, which was then aspirated under EUS guidance and cytology confirmed a benign cyst. After cyst decompression, the Zenker’s diverticulum was successfully treated using flexible endoscopic incisional therapy with the SB knife (image 3). Patient had complete resolution of her dysphagia with no symptom recurrence. DISCUSSION: Zenker’s diverticulum has been successfully treated with surgical and endoscopic techniques, but the presence of incidental cystic or vascular lesions highlight the need for endoscopic evaluation and use of adjunct tools such as endoscopic ultrasound to rule out vascular flow and assist in drainage before endoscopic therapy can be pursued. We report a unique case of cricopharyngeal septal cyst as the cause of symptomatic dysphagia within a Zenker’s diverticulum which was successfully treated with endoscopic interventional tools.