PMC7481499_01
Preoperative esophagogram showing Zenker's diverticulum.. A. Anteroposterior view; B. Lateral view. Size, 2.1 cm.
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The decision to perform Z-POEM was made after confirming the diagnosis by esophagography and gastroscopy (Fig. 1, Fig. 2).
Per-oral endoscopic myotomy for Zenker's diverticulum (Z-POEM) (A-H).. A. Endoscopic view of the Zenker's diverticulum, located 17 cm from the incisors; B. The submucosa was lifted by using glycerol with a few drops of indigo carmine injected 2 cm from the septum. C. Mucosal incision was performed by Endocut mode Effect 2,3 W; D. Submucosal tunneling and dissection was performed by Spray Coag Effect 1, 100 W along both sides of the septal wall until clearly identifying the bottom of the diverticulum and septal muscle was achieved.(arrow head) E. Myotomy was performed ; F. The last fiber of septal muscle was clearly identified at the bottom of diverticulum before cut.(arrow head) G. A mucosal defect; H. The mucosal defect closed by Through-the-scope clip (TTSC).
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Through-the-scope clips were applied to achieve mucosal apposition (Fig. 2).
Postoperative esophagogram found completely resolution of the diverticulum.
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Esophagography was repeated on postoperative day 7 to confirm that the diverticulum had been resolved (Fig. 3).