Divide and annex

  • Divide and annex Figure


A 64-year-old man presents with a 1-year history of dysphagia occurring intermittently before progressing to quotidian occurrence. Esophagram and subsequent EGD reveal a 5-cm Zenker’s diverticulum. He undergoes peroral endoscopic myotomy (Z-POEM) dividing the muscular septum and thus annexing the diverticular space into the esophageal lumen, which is uneventful. However, he returns in 1 month with recurrent dysphagia symptoms. Which of the following statements is true?

The Eckardt score is preferred over the Dakkak Bennett score in evaluating symptom severity in this patient. Z-POEM is preferred, given increased safety over endoscopic septotomy. Z-POEM is considered over endoscopic septotomy, as it may hypothetically decrease the risk of symptom recurrence. Z-POEM has recently been promoted over endoscopic septotomy because it is more cost-effective and has an accelerated learning curve.
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