A DIFFICULT Z-POEM DUE TO SEVERE FIBROSIS WAS AIDED BY A PARTIAL SEPTOTOMY WITH AN SB KNIFE AND COMPLETED WITH THE Z-POEM TECHNIQUE

A 60-year-old male presented with dysphagia and was found to have a 3 cm Zenker diverticulum. He was referred for endoscopic treatment.

A submucosal injection was followed by a mucosal incision at the septum.

Severe fibrosis was encountered on the surface preventing access to the submucosal space.

The SB knife was used to perform a limited septotomy. Following that the tunnel was entered and the Z poem was resumed with submucosal injections and a complete myotomy.

The mucosotomy was closed using clips.

Postoperative esophagram showed no leak. On follow-up 2 months later, dysphagia has completely resolved.

Publication History

Article published online:
14 April 2022