Counter mucosal incision with Zenker's peroral endoscopic myotomy: an innovative approach for mucosal decompression in Zenker’s diverticulum and mucosal webs
Background and Aims: Zenker’s diverticulum (ZD) is a pouch of the mucosa arising from the Killian triangle. Any size of symptomatic ZD or medium to large (2-3 cm or more) ZD needs intervention. Zenker's peroral endoscopic myotomy (Z-POEM) is the ideal first-line therapy for making the reliable...
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| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-09-01
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| Series: | VideoGIE |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468448125001201 |
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| Summary: | Background and Aims: Zenker’s diverticulum (ZD) is a pouch of the mucosa arising from the Killian triangle. Any size of symptomatic ZD or medium to large (2-3 cm or more) ZD needs intervention. Zenker's peroral endoscopic myotomy (Z-POEM) is the ideal first-line therapy for making the reliable myotomy. We aimed to demonstrate the latest Z-POEM techniques and counter mucosal incision (CMI) for a patient with larger-sized ZD and pre-existing esophageal mucosal webs near ZD. Methods: The CMI technique recently was developed by our hospital for antireflux intervention. It is a novel tension-relief technique of the mucosal plasty for enhancing closure stability. This time we performed esophageal mucosal incision on the opposite side of the Z-POEM defect closure part to relieve the mucosal tension and alleviate a postoperative stricture resulting from the tight clip closure in the background of the stiff surrounding mucosa and webs near the ZD. Results: We obtained complete eradication of ZD pouch without creating a stricture. Conclusions: CMI is the ideal approach for preventing a stricture related to the use of tight clip closure of the Z-POEM for a larger-sized ZD with a background of the surrounding mucosal webs. |
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| ISSN: | 2468-4481 |