Related Experiment Video
Updated: Jun 9, 2025
Use of the Scissor-Type Knife During the Peroral Endoscopy Myotomy Procedure for the Treatment of Achalasia
Published on: March 3, 2023
Short-term clinical and technical outcomes of a modified Zenker's peroral endoscopic myotomy with mucosal flap
Jose Antonio Almario1, Amit Mehta1, Apurva Shrigiriwar1
1Department of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, United States.
Background:
Zenker’s diverticulum peroral endoscopic myotomy (Z-POEM) is an effective treatment for symptomatic Zenker’s diverticulum. A modification to Z-POEM involves mucosal flap incision (MFI). We describe the technical and clinical success of patients who underwent Z-POEM with MFI.
Methods:
We included patients who underwent Z-POEM with MFI for Zenker’s diverticulum at eight international centers. The primary outcome was the rate of clinical success, assessed by post-procedure Kothari–Haber symptom score (KHSS) without re-treatment. Secondary outcomes included technical success, serious adverse events, and clinical recurrence with need for re-treatment.
Results:
36 patients (age 69 [SD 9] years; 69% male) underwent Z-POEM with MFI for symptomatic Zenker’s diverticulum. Mean diverticulum size was 3.2 (SD 1.4) cm. Clinical success was achieved in 35 patients (97%). Median baseline KHSS was 6 and median post-procedure KHSS was 0 (P < 0.001). Technical success was achieved in all cases. Mean procedure time was 57 (SD 34) minutes and median follow-up time was 196 days (interquartile range 39–499). There was one adverse event (3%), which was treated endoscopically.
Conclusion:
Z-POEM with MFI had high rates of technical and clinical success. Prospective evaluation is needed to further validate this technique in patients with a large Zenker’s diverticulum.
