Z-POEM (Per Oral Endoscopic Myotomy) for the management of large Zenker’s diverticulum

Zenker’s diverticulum is a rare disorder characterized by herniation of the post pharyngeal wall through Killan’s triangle (between the inferior constrictor muscle and cricopharyngeus muscle) (1). It occurs most commonly in males and elderly people. The exact etiology is unknown, however its postulated that its due to increased intraesophageal pressures together with spasm in the cricopharyngeus muscle (1). So, the treatment modalities were directed into cutting the cricopharyngeus (septum). Surgical intervention had been the current stay of treatment despite its relatively high related morbidity and mortality (2). Endoscopic intervention had aroused aiming into cutting the septum, but it carries the risk of perforation and incomplete cutting of the septum which comprises higher recurrence rates (3). In the past couple of years there had been sporadic reported cases in managing Zenker’s diverticulum by Per oral endoscopic myotomy (POEM) (4). POEM was first introduced by Prof.Inoue in japan 2010, which is based on the idea of tunneling or so called 3rd space endoscopy (5). The application of POEM had expanded lately to solve some tunneling endoscopic resection). Here we present the novel approach to Zenker’s diverticulum that had been tried recently in the last few years (Z-POEM).