Zenker's peroral endoscopic myotomy with myomectomy and ablation: a minimally invasive and effective technique for Zenker's diverticulum resolution.

BACKGROUND AND AIMS: Zenker's peroral endoscopic myotomy (Z-POEM) for Zenker's diverticulum is an effective first-line treatment; however, residual dysphagia may persist because of a remaining mucosal pouch. Currently, no standardized endoscopic method specifically addresses this issue. We present a novel approach: Z-POEM with adjunctive myomectomy and mucosal ablation (Z-POEM-MA), designed to achieve complete anatomical resolution in a single session.

METHODS

A 67-year-old man with progressive dysphagia and recurrent aspiration pneumonia was found to have a 4-cm Zenker's diverticulum. He underwent Z-POEM-MA, which included standard submucosal tunneling and cricopharyngeal myotomy, followed by myomectomy using a polypectomy snare, and subsequent mucosal ablation with argon plasma coagulation.

RESULTS

The procedure lasted 46 minutes with no adverse events. The patient resumed oral intake within 48 hours. Postoperative barium esophagram 1 month postoperatively showed complete resolution of the diverticulum. At 6 months, the patient remained asymptomatic, and upper endoscopy confirmed the absence of recurrence.

CONCLUSIONS

Z-POEM-MA is a feasible, safe, and potentially more effective technique compared with conventional Z-POEM, which targets both the muscular and mucosal components of Zenker's diverticulum. This approach may improve outcomes in patients with large pouches. Further studies are warranted to validate its long-term efficacy and reproducibility.