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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Elsevier
2025-09-01
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| Series: | VideoGIE |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468448125001201 |
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| author | Boldbaatar Gantuya, MD, PhD Haruhiro Inoue, MD, PhD Kazuki Yamamoto, MD, PhD Ippei Tanaka, MD Yohei Nishikawa, MD Kei Ushikubo, MD Mayo Tanabe, MD |
| author_facet | Boldbaatar Gantuya, MD, PhD Haruhiro Inoue, MD, PhD Kazuki Yamamoto, MD, PhD Ippei Tanaka, MD Yohei Nishikawa, MD Kei Ushikubo, MD Mayo Tanabe, MD |
| author_sort | Boldbaatar Gantuya, MD, PhD |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-0acbba167b2a40c0a4d58bffbcb07980 |
| institution | Kabale University |
| issn | 2468-4481 |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | VideoGIE |
| spelling | doaj-art-0acbba167b2a40c0a4d58bffbcb079802025-08-20T03:41:46ZengElsevierVideoGIE2468-44812025-09-0110944344710.1016/j.vgie.2025.04.011Counter mucosal incision with Zenker's peroral endoscopic myotomy: an innovative approach for mucosal decompression in Zenker’s diverticulum and mucosal websBoldbaatar Gantuya, MD, PhD0Haruhiro Inoue, MD, PhD1Kazuki Yamamoto, MD, PhD2Ippei Tanaka, MD3Yohei Nishikawa, MD4Kei Ushikubo, MD5Mayo Tanabe, MD6Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan; Department of Gastroenterology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia; Endoscopy Unit, Mongolia Japan Hospital of Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia; Corresponding author: Boldbaatar Gantuya, MD, PhD, Digestive Diseases Center, Showa University Koto Toyosu Hospital, 5-1-38 Toyosu, Koto-ku, Tokyo 135-8577, Japan.Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, JapanDigestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, JapanDigestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, JapanDigestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, JapanDigestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, JapanDigestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, JapanBackground 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.http://www.sciencedirect.com/science/article/pii/S2468448125001201 |
| spellingShingle | Boldbaatar Gantuya, MD, PhD Haruhiro Inoue, MD, PhD Kazuki Yamamoto, MD, PhD Ippei Tanaka, MD Yohei Nishikawa, MD Kei Ushikubo, MD Mayo Tanabe, MD Counter mucosal incision with Zenker's peroral endoscopic myotomy: an innovative approach for mucosal decompression in Zenker’s diverticulum and mucosal webs VideoGIE |
| title | Counter mucosal incision with Zenker's peroral endoscopic myotomy: an innovative approach for mucosal decompression in Zenker’s diverticulum and mucosal webs |
| title_full | Counter mucosal incision with Zenker's peroral endoscopic myotomy: an innovative approach for mucosal decompression in Zenker’s diverticulum and mucosal webs |
| title_fullStr | Counter mucosal incision with Zenker's peroral endoscopic myotomy: an innovative approach for mucosal decompression in Zenker’s diverticulum and mucosal webs |
| title_full_unstemmed | Counter mucosal incision with Zenker's peroral endoscopic myotomy: an innovative approach for mucosal decompression in Zenker’s diverticulum and mucosal webs |
| title_short | Counter mucosal incision with Zenker's peroral endoscopic myotomy: an innovative approach for mucosal decompression in Zenker’s diverticulum and mucosal webs |
| title_sort | counter mucosal incision with zenker s peroral endoscopic myotomy an innovative approach for mucosal decompression in zenker s diverticulum and mucosal webs |
| url | http://www.sciencedirect.com/science/article/pii/S2468448125001201 |
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