Peroral Endoscopic Myotomy for Zenker's Diverticulum: A Case Report.

Abstract: Zenker’s diverticulum (ZD) is a false diverticulum involving the mucosa and submucosa of the esophagus that forms a sac-like outpouching through Killian’s triangle in the upper esophagus. Symptoms associated with this condition including halitosis, dysphagia, regurgitation, and cough, are due to food trapping, incomplete opening of the upper esophageal sphincter, and compression of the esophagus by the diverticulum. ZD was historically treated with open surgical techniques including diverticulectomy, diverticulopexy, or cricopharyngeal myotomy. However, many of these methods have significant risks of complications, so endoscopic techniques have been at the forefront of permanent ZD treatment. Zenker peroral endoscopic myotomy (Z-POEM) is a novel procedure where an endoscope is passed into the esophagus and the cricopharyngeus muscle is cut following the creation of a submucosal tunnel. Z-POEM is a less invasive, lower risk, and faster procedure than surgery with comparable or improved outcomes compared to other endoscopic procedures. This is a case of a 60-year-old female patient with dysphagia found to have a Zenker diverticulum with significant symptom improvement following Z-POEM treatment.