We report a case of epiphrenic esophageal diverticulum that was resected 4 years 9 months after it was first observed. A 47-year-old man exhibited an epiphrenic esophageal diverticulum of 2.5 cm in size during a health screening examination. He was followed but was asymptomatic. About 4 years later, the diverticulum size was enlarged to 5 cm during the health screening examination. Six months later, he presented with symptoms, including heart burn and esophageal reflux. Resection of the diverticulum was performed with Heller myotomy, Dor fundoplication and Hill fixation. The postoperative course was good. In case of esophageal diverticulum, which is symptomatic or becomes enlarged during follow-up, surgery should be performed. As part of the surgical procedure, it is important to prevent post-operative esophageal reflux.