Peroral Endoscopic or Open Myotomy for Zenker’s Diverticulum

Zenker’s diverticulum is a false diverticulum of the cervical esophagus typically found in the geriatric population. The historic treatment for Zenker’s Diverticulum (ZD) is a surgical cricopharyngeal myotomy through a transcervical approach. The open approach results in good symptom control but is associated with severe adverse events. This has led to the development of less invasive endoscopic modalities. Zenker’s peroral endoscopic myotomy (Z-POEM) is an endoscopic technique that adopts the use of submucosal dissection from endoscopic treatment of achalasia. Compared with traditional surgical myotomy, Z-POEM has comparable clinical success and less long-term recurrence compared to prior endoscopic techniques, while decreasing the risk of serious complications.