Sealing the Gap: Innovative Use of Fibrin Sealant in the Zenker Peroral Endoscopic Myotomy Complication Management

The Zenker diverticulum is a pulsion diverticulum at the pharyngoesophageal junction, traditionally managed surgically. The Zenker peroral endoscopic myotomy offers a minimally invasive alternative, but secure closure of the mucosotomy is essential. We report a 65-year-old woman who developed pneumomediastinum following the Zenker peroral endoscopic myotomy due to proximal clip dehiscence. Initial lavage and endoscopic suturing failed. A subsequent session with argon plasma coagulation and fibrin sealant achieved complete closure, with rapid clinical recovery and resolution of pneumomediastinum. This case highlights fibrin sealant as a salvage adjunct when conventional closure methods are insufficient, and compares it with other closure techniques in terms of technical considerations, durability, and cost.