Per Oral Endoscopic Myotomy (POEM) for Zenker's Diverticulum

Video Type: CVideo
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Author: David Schwartzberg
Published:
Specialties: Endoscopy, General Surgery
Schools: NYU Langone Medical Center, New York University Langone Medical Center
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Basic Info

In contrast to major thoracic operations, per oral endoscopic myotomy for Zenker's diverticulum offers the possiblity to resect a symptomatic Zenker's under monitored anesthesia care (MAC) for patients to ill to undergo general anesthesia. Patients have similar functional results when compared to small Zenker's treated with traditional operative approaches.

DOI# http://dx.doi.org/10.17797/f3gyzc3k95

Advanced

Procedure

Per Oral Endoscopic Myotomy for Zenker's Diverticulum

Indications

Small (<4cm) symptomatic Zenker's diverticulum. Symptoms include halitosis, food intolerance, regurgitation or aspiration.

Contraindications

Coagulopathy, inability to tolerate endoscopy or anesthesia

Instrumentation

Setup

Endoscopy with monitored anesthesia care (MAC)

Preoperative Workup

Upper gastrointestinal series and/or endoscopy to document a small Zenke's diverticulum, basic labs including coagulation profile

Anatomy and Landmarks

Esophagus, cricopharyngeus, Zenker's diverticulum, longitudinal and circular layers of the esophagus

Advantages/Disadvantages

Advantages: patient does not have to undergo general anesthesia and avoids the morbidity associated with a thoracotomy. Disadvantages: cannot operatively correct large symptomatic Zenker's diverticulum, esophageal perforation

Complications/Risks

Aspiration, bleeding, infection, incomplete myotomy, esophageal perforation

Disclosure of Conflicts

None

Acknowledgements

Monmouth Medical Center, NJ Department of Surgery & Gastroenterology

References

POEM-Based Endoscopic Treatment of Zenker's Diverticulum: Minimal Incision Cricopharyngeal Myotomy (cpm) http://meetings.ssat.com/abstracts/2013/Su1623.cgi
Luke Mccrone*1, Kondal R. Kyanam Kabir Baig2, Victoria Gomez2, John D. Casler3, Timothy a. Woodward2
1Internal Medicine, Mayo Clinic Florida, Jacksonville, FL; 2Gastroenterology, Mayo Clinic Florida, Jacksonville, FL; 3Otorhinolaryngology, Mayo Clinic Florida, Jacksonville, FL

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