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Scardino et al. Mini-invasive Surg 2022;6:57 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2022.55

Review Open Access

Expanding the therapeutic options for Zenker’s

diverticulum: from open diverticulectomy to
transoral septoplasty

2
1
2
Andrea Scardino , Stefano Siboni , Pamela Milito , Luigi Bonavina 1,2
1
Department of Biomedical Sciences for Health, University of Milan, Milan 20097, Italy.
2
Division of General and Foregut Surgery, IRCCS Policlinico San Donato, Milan 20097, Italy.
Correspondence to: Dr. Luigi Bonavina, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, San Donato
Milanese, Milan 20097, Italy. E-mail: luigi.bonavina@unimi.it
How to cite this article: Scardino A, Siboni S, Milito P, Bonavina L. Expanding the therapeutic options for Zenker’s diverticulum:
from open diverticulectomy to transoral septoplasty. Mini-invasive Surg 2022;6:57. https://dx.doi.org/10.20517/2574-
1225.2022.55

Received: 13 Jul 2022 First Decision: 5 Aug 2022 Revised: 6 Sep 2022 Accepted: 30 Sep 2022 Published: 14 Nov 2022

Academic Editor: Giulio Belli Copy Editor: Jia-Xin Zhang Production Editor: Jia-Xin Zhang

Abstract
Significant technical changes and a shift toward a transoral approach have occurred in the management of Zenker’s
diverticulum over the past three decades. Transoral stapling is already an established and commonly performed
procedure. Zenker peroral endoscopic myotomy (Z-POEM) and Zenker peroral endoscopy septotomy (Z-POES)
are innovative techniques that are rapidly spreading and replacing more traditional therapeutic options. This review
provides an overview of the current status of minimally invasive transoral management to assess whether a
tailored approach is feasible and safe and may improve quality of life and reduce recurrence rates.

Keywords: Zenker diverticulum, cricopharyngeal myotomy, rigid endoscopy, flexible endoscopy, peroral
endoscopic myotomy, Z-POEM, Z-POES

INTRODUCTION
Zenker diverticulum (ZD) is an acquired mucosal pouch protruding from the Killian’s triangle.
Pathogenetic factors include altered upper esophageal sphincter coordination, reduced hypopharyngeal wall
compliance, and increased intrabolus pressure . It is considered a rare disease, with an estimated
[1,2]
prevalence of 0.11% or 2 per 100,000 persons per year, but the incidence will likely increase with the

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
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