Related Experiment Video
Updated: May 12, 2026
Use of the Scissor-Type Knife During the Peroral Endoscopy Myotomy Procedure for the Treatment of Achalasia
Published on: March 3, 2023
Zenker's peroral endoscopic myotomy with myomectomy and ablation: a minimally invasive and effective technique for
Oscar Victor Hernández Mondragón1, Kevin Josue Pintor Belmontes1
1Division of Endoscopy, Specialties Hospital, National Medical Center Century XXI, Mexico City, Mexico.
Background And Aims:
Zenker's peroral endoscopic myotomy (Z-POEM) for Zenker's diverticulum is an effective first-line treatment; however, residual dysphagia may persist because of a remaining mucosal pouch. Currently, no standardized endoscopic method specifically addresses this issue. We present a novel approach: Z-POEM with adjunctive myomectomy and mucosal ablation (Z-POEM-MA), designed to achieve complete anatomical resolution in a single session.
Methods:
A 67-year-old man with progressive dysphagia and recurrent aspiration pneumonia was found to have a 4-cm Zenker's diverticulum. He underwent Z-POEM-MA, which included standard submucosal tunneling and cricopharyngeal myotomy, followed by myomectomy using a polypectomy snare, and subsequent mucosal ablation with argon plasma coagulation.
Results:
The procedure lasted 46 minutes with no adverse events. The patient resumed oral intake within 48 hours. Postoperative barium esophagram 1 month postoperatively showed complete resolution of the diverticulum. At 6 months, the patient remained asymptomatic, and upper endoscopy confirmed the absence of recurrence.
Conclusions:
Z-POEM-MA is a feasible, safe, and potentially more effective technique compared with conventional Z-POEM, which targets both the muscular and mucosal components of Zenker's diverticulum. This approach may improve outcomes in patients with large pouches. Further studies are warranted to validate its long-term efficacy and reproducibility.
