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

  • Alessandro FugazzaEmail author
  • Roberta Maselli
  • Alessandro Repici


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.

A variety of techniques and devices have been reported to perform flexible endoscopic transoral cricopharyngeal myotomy. Usually, the incision of the septum is commonly obtained using a needle knife (normally used for endoscopic retrograde cholangiopancreatography/ERCP) or cutting devices designed for endoscopic submucosal dissection (ESD), such as a hook knife. Very recently, some authors have reported a novel technique, called the submucosal tunneling endoscopic septum division (STESD) or Z-POEM, where a submucosal tunnel is created in order to directly cut the muscle of the septum under direct vision. This chapter discusses the techniques and outcomes of flexible endoscopic management of Zenker’s diverticulum.


Zenker’s diverticulum Cricopharyngeal muscle Septotomy Flexible endoscopy myotomy Z-POEM 

Supplementary material

Video 20.1

Flexible endoscopic myotomy for Zenker’s diverticulum (MP4 136866 kb)


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Alessandro Fugazza
    • 1
    Email author
  • Roberta Maselli
    • 1
  • Alessandro Repici
    • 1
    • 2
  1. 1.Digestive Endoscopy Unit, Division of GastroenterologyHumanitas Research HospitalRozzanoItaly
  2. 2.Humanitas UniversityRozzanoItaly

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