Open transcervical diverticulectomy for recurrent Zenker's diverticulum after Z-POEM: a case report

Zenker's diverticulum is increasingly treated with endoscopic techniques, including peroral endoscopic myotomy (Z-POEM), but persistent or recurrent symptoms may still occur. We report a 77-year-old woman with longstanding dysphagia, regurgitation of undigested food, cough, and aspiration events despite prior endoscopic septotomy/Z-POEM. Repeat evaluation with barium swallow, computed tomography, and endoscopy confirmed a persistent large Zenker's diverticulum with retained contents. Given severe symptoms, aspiration risk, prior endoscopic failure, and altered cervical anatomy after previous thyroid surgery, she underwent open left transcervical diverticulectomy with cricopharyngeal myotomy. Recovery was uneventful apart from transient hoarseness, and follow-up showed marked improvement in swallowing and resolution of regurgitation and aspiration. This case highlights the importance of repeat imaging in symptomatic patients after Z-POEM and supports open transcervical repair as an effective salvage option in selected cases.