Post written by Linda Yun Zhang, MBBS, from the Division of Gastroenterology & Hepatology, Johns Hopkins Medicine, Baltimore, Maryland.

We present a 78-year-old woman with a short-septum Zenker’s diverticulum successfully treated with a mucosa preserving Zenker’s diverticulotomy. In this technique, in contrast to the original Zenker’s peroral endoscopic myotomy (Z-POEM) technique, mucosal incision and entry is performed directly above the Zenker’s septum.

Recently we have seen significant advancements in the management of Zenker’s diverticulum. Further, there has been increased recognition of both the condition itself and the available minimally invasive endoscopic options. We summarize the most commonly performed methods including traditional flexible endoscopic cricopharyngeal myotomy and Zenker’s peroral endoscopic myotomy (Z-POEM) and report a hybrid technique that incorporates concepts from both.

We summarized each of the techniques with schematic diagrams. We hope that through this video, endoscopists can gain a better understanding of the available endoscopic techniques. Further, we hope that this modified technique offers the benefits of the Z-POEM procedure (high rate of complete myotomy without increasing perforation risk) while avoiding the technically challenging aspect of tunneling and mucosal closure within the tight pharyngeal space. Further, we hoped to show that this remains a space open to further exciting advancements.

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