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Recurrence after Zenker’s peroral endoscopic myotomy despite complete septotomy: how far to go with myotomy on the esophageal side
Zenker’s diverticulum (ZD) is the most common diverticular disease found in the pharyngo-esophageal region.1 Zenker’s peroral endoscopic myotomy (Z-POEM) has been used incrementally for ZD with good efficacy and safety.2 Although Z-POEM provides the platform of submucosal tunneling that ensures a complete septotomy, recurrence to the tune of 14.7% are still reported after Z-POEM.3 Here we present a case of ZD that had recurrence after Z-POEM because of incomplete myotomy on the esophageal side, which was subsequently tackled with flexible endoscopic division of the residual esophageal muscular bridge.Zenker’s diverticulum: advancing beyond the tunnel
Zenker’s diverticulum (ZD) is attributed to a poorly compliant cricopharyngeus muscle, and the mainstay of treatment is a cricopharyngeal myotomy. We present a video series summarizing endoscopic treatment options for ZD and related conditions.Mucosa-preserving Zenker’s diverticulotomy
Zenker’s diverticulum (ZD) is a rare condition, with prevalence ranging between 0.01% to 0.11%.1 The mainstay of treatment is cricopharyngeal myotomy. Recently, flexible endoscopic cricopharyngeal myotomy (FECM) (Fig. 1) has become increasingly popular as a safe and effective alternative to open surgery and the rigid endoscopic approach. However, reported recurrence rates range from 0% to 32%,2 likely owing to a lack of procedure standardization and difficulty in performing adequate myotomy for fear of perforation, given the absence of mucosa preservation.Wire-guided and endoscopic-guided transesophageal echocardiographic probe insertion
Zenker's diverticulum (ZD) is the posterior pulsion diverticulum below the esophageal introitus through or above the cricopharyngeal muscle, and it is associated with a prominent cricopharyngeal bar.1,2 ZD can cause dysphagia, regurgitation of undigested food, cough, and aspiration of food particles. During endoscopy, ZD often creates difficulty in esophageal intubation. Flexible endoscopic treatment for ZD focuses on releasing the cricopharyngeal spasm by performing diverticulotomy on the septum.Functional luminal imaging probe technology to assess response after flexible endoscopic Zenker diverticulotomy
Zenker diverticulum (ZD) is rare, with an unknown overall prevalence, given that many patients with ZD are likely asymptomatic.1 ZDs are pseudodiverticula that manifest as mucosal and submucosal pulsion through the Killian triangle. Postulated mechanisms include increased intraesophageal pressure at an area of weakness in the proximal esophageal wall and hypertensive upper-esophageal sphincter (ie, decreased compliance). ZD is frequently diagnosed by esophagography. Symptoms include dysphagia, regurgitation, and, in severe cases, weight loss and malnutrition.Submucosal per-oral endoscopic myotomy for a large Zenker’s diverticulum with use of a hydrodissector knife and an over-the-scope clip closure
Zenker’s diverticulum (ZD) is a herniation of the posterior hypopharyngeal wall, outpouching for Killian’s triangle as a consequence of decreased compliance of an upper esophageal sphincter. The standard endoscopic approach is represented by the incision of septum together with the mucosa.1-7Difficult intubation of a Zenker's diverticulum with an acute angle
A 94-year-old woman was referred because of oropharyngeal dysphagia and previously failed intubation. A barium swallow had revealed Zenker’s diverticulum (ZD) and cricopharyngeal hypertrophy (Fig. 1).
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