Z-POEM Procedure

Innovative endoscopic treatment for Zenker’s diverticulum

The Zenker’s peroral endoscopic myotomy (Z-POEM) procedure is an innovative way to treat patients with Zenker’s diverticulum using endoscopic technology.

Understanding Zenker’s diverticulum

Zenker’s diverticulum happens when the semicircular muscle behind the adam’s apple over tightens causing the muscle in the throat above it, to pouch out. The pouch can increase in size over time, causing food to become stuck in the esophagus.

Zenker’s diverticulum outpouching can cause symptoms such as:

  • Difficulty/pain swallowing
  • Bad breath
  • Regurgitation of undigested food hours after eating
  • Coughing
  • Feeling of food sticking in the throat
  • Aspiration of food or liquid causing choking, bleeding, and unexplained weight loss

Your doctor will do a series of tests to diagnose Zenker’s diverticulum. Learn more about the symptoms, causes and other treatment options for Zenker’s diverticulum.

How is the Z-POEM procedure performed?

Z-POEM is a minimally invasive procedure that is done in an operating room. You will be sedated for this procedure with general anesthesia. This procedure takes around an hour and a half to complete.

While you are asleep, the doctor will use a thin, flexible tube to go down into your throat, then cuts across the soft tissue opening to expose the muscle. Once the muscle is exposed, two short tunnels are created. This is to completely expose the muscle while inside the small opening.

Next, the doctor can safely cut the muscle all the way down to the very last fiber, which guarantees no muscle is left behind. Then they close the small opening they created with short clips. These clips, once the opening heals, will fall out or down the esophagus into the stomach and out through the stool. As a result, food can move easily pass into the esophagus.

What to Expect with Z-POEM Procedure

Understanding Zenker’s diverticulum

Zenker’s diverticulum happens when the semicircular muscle behind the adam’s apple over tightens causing the muscle in the throat above it, to pouch out. The pouch can increase in size over time, causing food to become stuck in the esophagus.

Zenker’s diverticulum outpouching can cause symptoms such as:

  • Difficulty/pain swallowing
  • Bad breath
  • Regurgitation of undigested food hours after eating
  • Coughing
  • Feeling of food sticking in the throat
  • Aspiration of food or liquid causing choking, bleeding, and unexplained weight loss

Your doctor will do a series of tests to diagnose Zenker’s diverticulum. Learn more about the symptoms, causes and other treatment options for Zenker’s diverticulum.

How is the Z-POEM procedure performed?

Z-POEM is a minimally invasive procedure that is done in an operating room. You will be sedated for this procedure with general anesthesia. This procedure takes around an hour and a half to complete.

While you are asleep, the doctor will use a thin, flexible tube to go down into your throat, then cuts across the soft tissue opening to expose the muscle. Once the muscle is exposed, two short tunnels are created. This is to completely expose the muscle while inside the small opening.

Next, the doctor can safely cut the muscle all the way down to the very last fiber, which guarantees no muscle is left behind. Then they close the small opening they created with short clips. These clips, once the opening heals, will fall out or down the esophagus into the stomach and out through the stool. As a result, food can move easily pass into the esophagus.

Do I have to stay the night in the hospital?

No. This is an outpatient procedure, but there is always the possibility of an overnight stay if needed.

After the procedure your doctor will order an esophagram to make sure the surgical area is intact. This X-ray takes pictures of the entire esophagus.

Once this is read by a radiologist, you will start on a liquid diet. Over-the-counter pain medication is sometimes needed, but most patients have minimal pain the next day.

What happens when I go home? Going back to work?

Your diet will progress to a soft diet after the first three days and our nurse will follow-up with you two weeks after your procedure.

You will resume all home medications when you go home unless otherwise instructed by your doctor. Along with your home medications, you will be given a course of antibiotics to finish over the next five days to prevent infection.

All patients are given a lifting restriction on nothing greater than 15 pounds for the first two weeks. You can return to light-duty work the day after your discharge. If you require a note for your profession, please ask your doctor.

Will I need to come back for additional procedures?

Yes. Z-POEM patients come back for testing at 4-6 weeks after procedure which includes:

  • An upper endoscopy (EGD)
  • Clip removal

You will return to your referring GI physician after your follow-up visit.

After your Z-POEM procedure

Do I have to stay the night in the hospital?

No. This is an outpatient procedure, but there is always the possibility of an overnight stay if needed.

After the procedure your doctor will order an esophagram to make sure the surgical area is intact. This X-ray takes pictures of the entire esophagus.

Once this is read by a radiologist, you will start on a liquid diet. Over-the-counter pain medication is sometimes needed, but most patients have minimal pain the next day.

What happens when I go home? Going back to work?

Your diet will progress to a soft diet after the first three days and our nurse will follow-up with you two weeks after your procedure.

You will resume all home medications when you go home unless otherwise instructed by your doctor. Along with your home medications, you will be given a course of antibiotics to finish over the next five days to prevent infection.

All patients are given a lifting restriction on nothing greater than 15 pounds for the first two weeks. You can return to light-duty work the day after your discharge. If you require a note for your profession, please ask your doctor.

Will I need to come back for additional procedures?

Yes. Z-POEM patients come back for testing at 4-6 weeks after procedure which includes:

  • An upper endoscopy (EGD)
  • Clip removal

You will return to your referring GI physician after your follow-up visit.

Patient Stories for Z-POEM Procedure