Commentary

Flexible endoscopic treatment for Zenker’s diverticulum (ZD) was introduced in the mid-1990s as an alternative to the surgical technique using rigid endoscopes. It is performed by direct incision of the septum from the esophageal lumen into the diverticular space. This case illustrates the importance of incising the septum to the bottom of the diverticular space to minimize recurrences.

A recently described technique is submucosal tunneling endoscopic septum division, inspired by peroral endoscopic myotomy (POEM). Termed Z-POEM, it involves creating a submucosal tunnel to achieve a complete myotomy.

Although in Western hands, direct septotomy will be preferred for now because it is likely to be experienced as technically easier than Z-POEM, comparative studies are needed to determine which technique has the best treatment success and lowest risk of complications.

Publication History

Article published online:
25 March 2020