Endoscopic Myotomy for Zenker’s Diverticulum (Z-POEM)

Abstract

Zenker’s diverticulum (ZD) is a rare disease with a reported prevalence of 0.01% to 0.11% which typically presents in elderly individuals. Classical symptoms of ZD are dysphagia, regurgitation, halitosis, chronic cough, foreign body sensation, aspiration pneumonia, and weight loss. In the past, the mainstay of management for ZD was an open surgical approach through a neck incision and subsequent myotomy of the upper esophageal sphincter (UES) and removal or suspension of the diverticulum. Therapy of symptomatic ZD, however, has evolved over the last 30 years from an open surgical approach to less invasive, incisionless, transoral endoscopic techniques. Transoral endoscopic approach by using rigid instruments is performed primarily by otorhinolaryngologists, whereas transoral therapy using flexible endoscopes is performed by endoscopists with devices developed for advanced tissue resection. The common goal of both transoral modalities is severing of the septum between the esophageal lumen and the diverticulum containing the cricopharyngeal muscle. The potential advantages of flexible endoscopy over the conventional open surgical approach or rigid endoscopy are the absence of cutaneous incision, shorter operative time, reduced postoperative discomfort, faster return to oral feeding, and shorter length of hospital stay.