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RYAN LAW: With the treatment of Zenker's diverticulum, there's been an evolution over the last several decades with a goal to provide minimally invasive interventions that are aimed at improved outcomes. The definitive diagnosis for a Zenker's diverticulum is an upper endoscopy where the diverticulum would be seen directly as the scope passes into the esophagus. Another way to diagnose this condition is with a barium or contrast esophagram. Symptoms can include difficulty swallowing to the point where there's frequent regurgitation. In the most severe cases, patients may actually aspirate food or liquid into their lungs.
Historically, Zenker's diverticulum was treated surgically with an open neck dissection and actual removal of the diverticulum from the esophagus. Current minimally invasive therapies include both flexible and rigid endoscopic approaches. The rigid endoscopic approach involves placement of a rigid scope in the back of the throat and into the proximal esophagus, followed by passage of any number of tools to divide the cricopharyngeus muscle. The flexible procedure is performed by passing the endoscope to the level of the diverticulum. And subsequently, the cricopharyngeus is divided using a variety of methods.
The final approach developed within the last five years is something called a Zenker's POEM, or Zenker's per-oral endoscopic myotomy. During a Zenker's POEM, a small submucosal tunnel is created immediately proximal to the level of the hypertrophic cricopharyngeus muscle. The scope is then passed underneath the lining of the proximal GI tract into the submucosal space, and a tunnel is created on both sides of this hypertrophic muscle. The muscle is then subsequently divided using an electric knife. And the only requirement at that point to prevent adverse events is proper closure of the tunnel that we've created, which usually is a 1 to 2 centimeter opening at the very proximal aspect of the esophagus.
A major benefit of the Zenker's POEM approach is the ability to preserve the overlying mucosa of the proximal esophagus, therefore, minimizing the risk of infection after tunnel closure. Using the Z-POEM approach, it's very easy to identify anatomical landmarks as well as identifying the problem musculature that requires treatment.
Here at Mayo Clinic, we have as much experience as anybody in the country managing this condition. We also have clinicians who are willing to take a multidisciplinary approach on a patient-by-patient basis to determine which approach may be right for each particular patient. The advent of Z-POEM is one such therapy where we continue to try and find new therapies, novel innovations to improve our patients' lives with the least risk to them as possible.
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