Zenker's Per-oral Endoscopic Myotomy (ZPOEM)

What is a ZPOEM?

ZPOEM or Z-POEM is a minimally invasive endoscopic procedure used to treat a condition called Zenker’s diverticulum — a pouch that forms in the upper part of the oesophagus (food pipe), just behind the throat.

This condition can cause:

• Difficulty swallowing (dysphagia)
• Coughing or choking while eating
• Regurgitation of food
• Bad breath
• Recurrent chest infections

Z-POEM helps by cutting the muscle between the oesophagus and the pouch, allowing food to pass more easily and reducing symptoms.

Why is Z-POEM recommended?

Z-POEM may be recommended if you:

•     Have moderate to severe symptoms from Zenker’s diverticulum
•     Are not responding to conservative treatments
•     Want to avoid open surgery
•     Are older or at higher risk for traditional surgical options

How is the Z-POEM procedure done?

•     You will receive general anaesthesia.
•     A flexible tube (endoscope) is passed through your mouth into your oesophagus.
•     A small cut is made in the lining of the oesophagus above the pouch.
•     A tunnel is created beneath the surface to reach the muscle between the pouch and the oesophagus.
•     The tight muscle (the cricopharyngeal muscle) is cut (myotomy).
•     The entry site is sealed with small clips, which fall off on their own after a few weeks.

What are the benefits?

•     Minimally invasive: No external cuts or scars
•     Relief of swallowing difficulties
•     Faster recovery and shorter hospital stay
•     Fewer complications compared to open surgery
•     Suitable for older or higher-risk patients

What are the risks?

Z-POEM is generally safe, but like all procedures, there are some risks:

What happens after the procedure?

•      You will stay in hospital for 1 night for observation.
•      You’ll start with a liquid diet, then slowly move to soft and solid foods over several days.
• You will likely have:
  • •     Antibiotics to prevent infection
    •     Acid-reducing medications (omeprazole) for healing
•      You’ll have a follow-up appointment to assess your recovery and check for symptom improvement.

Frequently Asked Questions

Q: Will this cure my swallowing problem?
A: Z-POEM greatly improves symptoms in most people. Some may have minor residual symptoms or need repeat procedures in rare cases.

Q: Will I have any scars?
A: No. The procedure is done entirely through the mouth.

Q: How soon can I eat and return to normal life?
A: You’ll start on liquids the day after the procedure and return to normal activities within a few days.

Q: How successful is Z-POEM?
A: Studies show success rates over 90% in improving swallowing and quality of life.