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Dig Endosc. 2017 Sep 6. doi: 10.1111/den.12958. [Epub ahead of print]

Zenker's diverticulum. Submucosal tunneling endoscopic septum division. (Z-POEM).

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Division of Endoscopy, Specialties Hospital, National Medical Center Century XXI, Mexico City, Mexico.
Gastroenterologist and Therapeutic Endoscopy Specialist.
Gastrointestinal Surgeon and Fellow in training of Therapeutic Endoscopy.
Gastroenterologist and chief of Endoscopy Department.



Zenker diverticulum is characterized by dysphagia, weight loss and bronchoaspiration [1]. Open surgery has been the cornerstone of treatment, with good response but recurrence up to 35%.[2]. Rigid endoscopic diverticulotomy has similar results, but with conversion to open surgery up to 30%[3]. Flexible endoscopic diverticulotomy is safe, effective and can be performed in an endoscopic setting, but multiple sessions are needed because of uncomplete cut of the septum[4,5]. Z-POEM is a new procedure in which a total septum myotomy throughout a submucosal tunnel can be performed. We describe this technique in an 85 years-old-male with big size zenker's diverticulum.


After confirmation of a 35mm Zenker's diverticulum, we performed procedure using an electrosurgical unit ERBE model VIO-200D, a regular endoscope coupled with a homemade cap and a CO2 insufflator. Flush knife model DK2618J(Fujinon, Japan), a sclerotherapy needle(Boston Scientific, USA), and resolution clips(Boston Scientific, USA).


First: creation of a submucosal bleb 3cms above the septum with a 10mm longitudinal incision. Second: submucosal tunnel was created up to the diverticular septum. Third, total myotomy of the septum and fourth, a mucosal closure was performed with 5 clips. Characteristics of procedure were documented.


Z-POEM was performed successfully without adverse events during or after procediure. Barium esophagram test showed a decrease of more than 80% of the original diverticular size (6mm), and no bronchoaspiration signs were observed. The patient was discharged at 48hrs after Z-POEM and at 1 month after, no dysphagia was observed and patient can eat a normal diet.


Z-POEM or so called submucosal tunneling endoscopic septum division technique is a safe and effective procedure for the treatment of Zenker's diverticulum with the advantages of a complete septum division, faster recovery and that can be performed in patients with different diverticular sizes an even with high comorbidities. This article is protected by copyright. All rights reserved.

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