Background <p>Treatment of Zenker’s diverticulum (ZD) has been revolutionized with the introduction of endoscopic techniques. Z-POEM has been shown to have excellent safety and efficacy. We report our experience with the Z-POEM for the treatment of ZD.</p> Methods <p>This is a single-institution retrospective study from 2020 to 2024. The primary outcome was clinical success, defined as improvement in dysphagia score to ≤ 1 without need for a reintervention the first 6&#xa0;months. Secondary outcomes included technical success, rate of reintervention, and post-procedural complications.</p> Results <p>A total of 32 patients (male 62.5%, mean age 74.2 ± 10.7&#xa0;years) underwent Z-POEM for treatment of Zenker’s diverticulum. The mean diverticulum size was 26.7 ± 9.9&#xa0;mm. The American Society of Anesthesiologists (ASA) grade was 3 in 56.3% of patients; the rest of the patients were ASA grade 2. Technical success was achieved in 100% of patients (<i>n</i> = 32) and clinical success was achieved in 96.9% of patients (<i>n</i> = 31). The mean procedure time was 48.6 ± 19.1&#xa0;min. More than two thirds of the patients (68.8%) were discharged home the same day. One patient developed atrial fibrillation postprocedurally. Mean dysphagia scores improved from 1.5 ± 0.8 before the procedure to 0.09 ± 0.3 after the procedure at most recent follow-up (<i>p</i> &lt; 0.001). Mean regurgitation scores improved from 2.3 ± 1.2 before the procedure to 0.13 ± 0.3 after the procedure at most recent follow-up (<i>p</i> &lt; 0.001). Reintervention due to recurrence of symptoms was required in six patients (18.8%) during a mean length of follow-up of 10.8&#xa0;months (range 1 to 43&#xa0;months). Most of the reinterventions (80%) were required after 17&#xa0;months from the initial Z-POEM.</p> Conclusions <p>Z-POEM is a safe, effective, and durable treatment for Zenker’s diverticulum, but reoperation is needed in 1 out of 5 patients in the short term.</p>