Commentary

The featured video in this issue of Endoscopy introduces a modification of the technique for peroral endoscopic myotomy of Zenker’s diverticulum (Z-POEM), aimed at shorter procedure times and improved treatment for recurrent diverticula. However, its broad adoption requires consideration of two key aspects. Firstly, the nonstandardized nature of Z-POEM and existing modifications should be acknowledged [1]. Peroral endoscopic septotomy (POES) has already streamlined procedures for short-septum diverticulum (shorter time and no tunneling) [2]. In recurrent diverticula, a hybrid technique combines septotomy and tunneling for completion [1]. Secondly, the effectiveness of the modified Z-POEM should be compared directly to that of the originally proposed approach. Uncertainty arises regarding whether preserving mucosal and submucosal layers achieves similar outcomes in terms of reduction of symptoms. The ongoing ZIPPY trial has shown that reduction in procedure time is achieved with endoscopist experience [3]. Therefore it is unclear whether the modification of technique or operator proficiency is responsible for shorter procedure time. Lastly, we should remember that procedural success may not be accurately reflected by procedure time alone.

Publication History

Article published online:
28 November 2023

• References

• 1 Zhang LY, Nieto J, Ngamruenphong S. et al. Zenker’s diverticulum: advancing beyond the tunnel. VideoGIE 2021; 6: 562-567 DOI: 10.1016/j.vgie.2021.08.003.
• 2 Repici A, Spadaccini M, Belletrutti PJ. et al. Peroral endoscopic septotomy for short-septum Zenker’s diverticulum. Endoscopy 2020; 52: 563-568 DOI: 10.1055/a-1127-3304.
• 3 Budnicka A, Januszewicz W, Bialek AB. et al. Peroral endoscopic myotomy in the management of Zenker’s diverticulum: a retrospective multicenter study. J Clin Med 2021; 10: 187 DOI: 10.3390/jcm10020187.xxx.