Modified Peroral Endoscopic Myotomy for Zenker's Diverticulum With Increased Effectiveness, Safety, and Durability

In this video, the authors present their technique with modifications to the peroral endoscopic myotomy for Zenker’s diverticulum (Z-POEM). They believe this leads to increased effectiveness, safety, and durability of results.

The patient is a sixty-nine-year-old man with a significantly symptomatic Zenker’s diverticulum as shown on a preoperative barium swallow. The patient had limited mouth opening and comorbidities that make the endoscopic stapled and open surgical options less desirable.

The surgical video breaks down the procedure step by step, including preoperative preparation, materials, and technical modifications and pearls which make Z-POEM highly effective and safe in the treatment of this disease.

Later in the video, the authors show temporal improvement in the Dakkak dysphagia score and Eckardt achalasia score from preoperatively up to four years postoperatively. They also show immediate and four-year postoperative barium swallows, which demonstrate complete obliteration of the diverticulum with no impedance to contrast flow at the upper esophageal sphincter.

The authors believe that their Z-POEM technique is superior to endoscopic stapled myotomy, which requires the insertion of the Weerda scope and performs incomplete myotomy due to residual muscle at the tip of the stapler. Compared to the open repair, Z-POEM is incisionless and carries no risk to the recurrent laryngeal nerve.