Z-POEM offers minimally invasive treatment for Zenker's diverticulum in elderly patients with high surgical risks

BackgroundZenker's diverticulum (ZD) is a rare esophageal disorder, and traditional surgical interventions are associated with significant trauma and poor tolerance in elderly patients.Case summaryAn 85-year-old female presented with a one-year history of progressive dysphagia, accompanied by regurgitation, coughing, and a 5 kg weight loss. Diagnostic evaluations, including barium esophagography, chest computed tomography (CT), and endoscopy, confirmed an upper esophageal ZD (3 cm in diameter).TreatmentThe patient underwent submucosal tunneling endoscopic septum division (STESD), which is widely standardized in current literature as Zenker's peroral endoscopic myotomy (Z-POEM). Key procedural steps included mucosal incision, submucosal tunneling, complete septum myotomy, and mucosal closure using titanium clips. Postoperative recovery was uneventful, with no complications such as bleeding or perforation.ConclusionZ-POEM demonstrates minimally invasive advantages, safety, and efficacy in treating ZD, particularly for elderly patients with high surgical risks. This technique represents a promising therapeutic option in this population.