key: cord-1034765-ti3uf6gj
authors: Young, Edward; Singh, Rajvinder
title: Modified Zenker’s peroral endoscopic myotomy: a novel technique to improve access and depth of muscular dissection
date: 2022-02-17
journal: VideoGIE
DOI: 10.1016/j.vgie.2022.01.007
sha: 67837588ad0480ca778785730bbccb4c6c31ad23
doc_id: 1034765
cord_uid: ti3uf6gj

Video 1The modified Zenker's peroral endoscopic myotomy technique to treat a large Zenker's diverticulum.

However, possible limitations of Z-POEM include limited access to the submucosal tunnel because of the proximity of the upper esophageal sphincter, as well as the requirement for submucosal tunneling, which can lead to inability to locate the cricopharyngeal muscle. 2 Endoscopic Zenker's diverticulotomy maximizes access to the field of dissection but limits depth of muscle transection. 4 Alternatively, the Z-POEM technique can be modified by placing the mucosotomy directly over the septum, using either a parallel or perpendicular incision as has been described by Mavrogenis et al and Repici et al (but previously in the context of a short diverticular septum). 5, 6 In this case, a perpendicular incision was made to maximize access for submucosal dissection on either side of the septum; however, in the context of a smaller diverticulum with a narrow septum, a parallel incision may reduce the risk of complications. This modified Z-POEM technique can be used to treat large diverticula (Video 1, available online at www. giejournal.org), maximizing access to the field of dissection and allowing closure of the mucosal defect to be completed safely and carefully. In addition, submucosal tunnels on each side of the cricopharyngeal muscle facilitate accurate and deep muscular transection, which may lead to improved clinical efficacy.

Although formal studies are required to compare the efficacy and safety of this modified approach in comparison to both traditional Z-POEM and Zenker's diverticulotomy, in this case it led to a highly successful clinical outcome with excellent access to the field of dissection and careful closure of the mucosal incision. 4 . A, Transection of the cricopharyngeal muscle, which is clearly exposed after submucosal dissection on either side of the septum. B, Improved working space for mucosotomy closure compared to traditional Zenker's peroral endoscopic myotomy.

VideoGIE is now indexed in PubMed Central.

VideoGIE is an Open Access, online-only journal indexed in PubMed Central. Submit video cases of endoscopic procedures used in the study, diagnosis, and treatment of digestive diseases.

VideoGIE publishes the following article types:

• Case Reports: Reports of the diagnosis and management of digestive diseases using a single case.

• Case Series: Reports of the diagnosis and management of digestive diseases using 3 or more cases.

• Tools and Techniques: Educational videos demonstrating the use of a particular endoscopic tool or technique. The goal of this section is to help trainees, endoscopy nurses, and technicians learn how best to use the tools of endoscopy for high-quality care.

Zenker's diverticulum: can protocolised measurements with barium SWALLOW predict severity and treatment outcomes? The "Zen-Rad" Study

An international study on the use of peroral endoscopic myotomy in the management of Zenker's diverticulum

Peroral endoscopic myotomy as treatment for Zenker's diverticulum (Z-POEM): a multi-center international study

Flexible endoscopic Zenker's diverticulotomy

Mucosotomy at the top of the septum facilitates tunneling and clipping during peroral endoscopic myotomy for Zenker's diverticulum (Z-POEM)

Peroral endoscopic septotomy for short-septum Zenker's diverticulum

University of Adelaide, Faculty of Health and Medical Sciences

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