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Per-oral Endoscopic Myotomy (Z-POEM): An Effective Treatment for Zenker's Diverticulum with Long-Term Results

ACTA MEDICA INDONESIANA · Vol. 57 No. 3 (2025)

ISSN
2338-2732, 0125-9326
Published
2025-10-03
Publisher
The Indonesian Society of Internal Medicine
Language
eng
License
creativecommons.org/licenses/by/4.0

Abstract

Zenker's diverticulum (ZD) arises from impaired cricopharyngeal (CP) muscle distensibility during deglutition (swallowing), leading to a clinical presentation characterised by dysphagia, regurgitation, aspiration, cough, and potential weight loss. The definitive treatment for ZD is a CP myotomy. Traditionally, open surgical approaches (transcervical diverticulectomy, diverticulopexy, or diverticular inversion) with or without concomitant CP myotomy and rigid endoscopic techniques utilizing stapling or CO2 laser therapy have been employed. However, these interventions are often associated with significant morbidity and mortality, particularly in the elderly and comorbid ZD patient population. The advent of flexible endoscopic ZD treatment has revolutionized the therapeutic landscape, rapidly becoming the preferred first-line modality for the management of small to moderate-sized diverticula. The past decade has witnessed the emergence of a multitude of novel techniques within the realm of flexible endoscopic ZD treatment. In this medical illustration, we report a woman, 64-years-old with Zenker’s diverticulum treated with Z-POEM. She came to our clinic with dysphagia and regurgitation for 6 months prior. Diagnostic gastroscopy showed ZD of 3 cm, located 18 cm from incisors with a thick septal muscle. A triangle-shaped knife created a 2-cm mucosal incision, and submucosal tunneling was made by spray coagulation. The gastroscope was advanced through the submucosal space of the esophageal lumen and the diverticulum site until the bottom of the diverticulum. The septal muscle was completely cut, immediately allowing the gastroscope to pass through easily, and the mucosal defect was closed with hemoclips. Six months after the treatment, the patient no longer experiences dysphagia and regurgitation. Z-POEM offers a precise approach to treating Zenker's diverticulum by providing a complete visualization of the entire septal muscle. This comprehensive view minimizes the risk of incomplete myotomy, ensuring a more effective treatment.

Keywords

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40 authors · 177 co-authorship links · showing the 40 most connected

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Co-authorOrganisationJoint articles
Dadang MakmunAffiliation unknown8
Murdani AbdullahAffiliation unknown7
Hamzah ShatriAffiliation unknown7
Marcellus SimadibrataAffiliation unknown5
Hasan MaulahelaAffiliation unknown4
Kaka RenaldiAffiliation unknown4
Siti SetiatiAffiliation unknown3
Cleopas Martin RumendeAffiliation unknown3
Amanda Pitarini UtariAffiliation unknown3
Rabbinu Rangga PribadiAffiliation unknown3
Virly Nanda MuzellinaAffiliation unknown3
Ikhwan RinaldiAffiliation unknown3
Nikko DarnindroAffiliation unknown2
Ari F SyamAffiliation unknown2
Adityo SusiloAffiliation unknown2
Rudy HidayatAffiliation unknown2
Nury NusdwinuringtyasAffiliation unknown2
Aria KekalihAffiliation unknown2
Agus Dwi SusantoAffiliation unknown2
Siti Chandra WidjanantieAffiliation unknown2
Maria Regina RachmawatiAffiliation unknown2
Won Ah ChoiAffiliation unknown2
Seong Woong KangAffiliation unknown2
Cleopas M RumendeAffiliation unknown2
Nur RahadianiAffiliation unknown2
Mila NovitaAffiliation unknown1
Jurica LucyandaAffiliation unknown1
Fadil PermanaAffiliation unknown1
Tifani MargarethaAffiliation unknown1
Rachmat PramuktyAffiliation unknown1
Khoiruddin MuchtarAffiliation unknown1
Ahmad FuadAffiliation unknown1
Radhiyatam MardhiyahAffiliation unknown1
Ening KrisnuhoniAffiliation unknown1
Mardiastuti H WahidAffiliation unknown1
Rike SyahniarAffiliation unknown1
Andi YasmonAffiliation unknown1

Affiliations come from OpenAlex; journal OAI-PMH metadata carries none. Authors without an OpenAlex ID are matched by name, which can merge or split people.

Metadata source: OAI-PMH (metadata jurnal) http://www.actamedindones.org/index.php/ijim/oai, first harvested 8 Nov 2026, last seen 8 Nov 2026.
Original metadata (oai_dc) 
<oai_dc:dc xmlns="http://www.openarchives.org/OAI/2.0/" xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/  http://www.openarchives.org/OAI/2.0/oai_dc.xsd">
	<dc:title xml:lang="en-US">Per-oral Endoscopic Myotomy (Z-POEM): An Effective Treatment for Zenker's Diverticulum with Long-Term Results</dc:title>
	<dc:creator>Fauzi, Achmad</dc:creator>
	<dc:creator>Nursyirwan, Saskia Aziza</dc:creator>
	<dc:creator>Syam, Ari Fahrial</dc:creator>
	<dc:subject xml:lang="en-US">gastroenterology</dc:subject>
	<dc:subject xml:lang="en-US">endoscopy</dc:subject>
	<dc:subject xml:lang="en-US">third space endoscopy</dc:subject>
	<dc:subject xml:lang="en-US">endoscopic myetomy</dc:subject>
	<dc:subject xml:lang="en-US">Zenker's diverticulum</dc:subject>
	<dc:description xml:lang="en-US">Zenker's diverticulum (ZD) arises from impaired cricopharyngeal (CP) muscle distensibility during deglutition (swallowing), leading to a clinical presentation characterised by dysphagia, regurgitation, aspiration, cough, and potential weight loss. The definitive treatment for ZD is a CP myotomy. Traditionally, open surgical approaches (transcervical diverticulectomy, diverticulopexy, or diverticular inversion) with or without concomitant CP myotomy and rigid endoscopic techniques utilizing stapling or CO2 laser therapy have been employed. However, these interventions are often associated with significant morbidity and mortality, particularly in the elderly and comorbid ZD patient population.
The advent of flexible endoscopic ZD treatment has revolutionized the therapeutic landscape, rapidly becoming the preferred first-line modality for the management of small to moderate-sized diverticula. The past decade has witnessed the emergence of a multitude of novel techniques within the realm of flexible endoscopic ZD treatment.
In this medical illustration, we report a woman, 64-years-old with Zenker’s diverticulum treated with Z-POEM. She came to our clinic with dysphagia and regurgitation for 6 months prior.  Diagnostic gastroscopy showed ZD of 3 cm, located 18 cm from incisors with a thick septal muscle. A triangle-shaped knife created a 2-cm mucosal incision, and submucosal tunneling was made by spray coagulation. The gastroscope was advanced through the submucosal space of the esophageal lumen and the diverticulum site until the bottom of the diverticulum. The septal muscle was completely cut, immediately allowing the gastroscope to pass through easily, and the mucosal defect was closed with hemoclips. Six months after the treatment, the patient no longer experiences dysphagia and regurgitation.
Z-POEM offers a precise approach to treating Zenker's diverticulum by providing a complete visualization of the entire septal muscle. This comprehensive view minimizes the risk of incomplete myotomy, ensuring a more effective treatment.</dc:description>
	<dc:publisher xml:lang="en-US">The Indonesian Society of Internal Medicine</dc:publisher>
	<dc:date>2025-10-03</dc:date>
	<dc:type>info:eu-repo/semantics/article</dc:type>
	<dc:type>info:eu-repo/semantics/publishedVersion</dc:type>
	<dc:format>application/pdf</dc:format>
	<dc:identifier>http://www.actamedindones.org/index.php/ijim/article/view/2947</dc:identifier>
	<dc:source xml:lang="en-US">Acta Medica Indonesiana; Vol. 57 No. 3 (2025): Acta Medica Indonesiana; 403</dc:source>
	<dc:source>2338-2732</dc:source>
	<dc:source>0125-9326</dc:source>
	<dc:language>eng</dc:language>
	<dc:relation>http://www.actamedindones.org/index.php/ijim/article/view/2947/821</dc:relation>
	<dc:rights xml:lang="en-US">Copyright (c) 2025 Achmad Fauzi, Saskia Aziza Nursyirwan, Ari Fahrial Syam</dc:rights>
	<dc:rights xml:lang="en-US">https://creativecommons.org/licenses/by/4.0</dc:rights>
</oai_dc:dc>