Endoscopic Zenker Peroral Endoscopic Myotomy (Z-POEM) is beginning to establish itself as a valuable, minimally invasive treatment option for Zenker’s Diverticulum (ZD). However, the available evidence regarding this approach is still growing. This study aims to assess the technical and clinical performance of endoscopic Z-POEM for ZD, specifically evaluating technical success rates, clinical efficacy, the length of hospitalization, and the occurrence of adverse events.

We included all patients that underwent Z-POEM for Zenker’s diverticulum in our Center from February 2022 to August 2025, collected through a prospectively maintained database. The primary outcome we evaluated was clinical success, measured by symptomatic improvement based mainly on the resolution of dysphagia and defined by a Kothari-Haber score <3 at 3 months, and for the patients with a long enough follow up, at 1 year. As for secondary outcomes, we evaluated technical success, length of hospital stay, and incidence of adverse events.

In total, 30 patients were treated with Z-POEM (males 66%, mean age 73,7 ± 7,6 years), all with Zenker diverticula and one with concomitant esophageal spasm; we excluded 4 patients with exclusive esophageal spasm without presence of a diverticulum. Most patients were naïve, while 4 had already undergone treatment for ZD, 2 of them through a surgical approach and 2 endoscopic, experiencing symptom recurrence a few years post treatment. The average pre-procedural Kothari-Haber score in our population was 5,73 (± 1,8), with all patients presenting with dysphagia and many experiencing daily regurgitations along with weight loss and halitosis. The mean size of the diverticulum was 2,16 cm. Technical success was observed in 100% of cases and clinical success was achieved in 100% of patients, with a post-procedural Kothari-Haber score ≤1 in all patients at 3 months post treatment. For the 21 patients treated until September 2024 the Kothari-Haber score was still ≤1 at the 1 year follow up, and no patient suffered from symptom recurrence. The average duration of hospitalization was 2,03 days. No patient experienced post-procedural adverse events, which we also documented by contrast X-ray performed at 24 hours before attempting refeeding. All patients restarted oral feeding without complications before discharge.

Endoscopic Z-POEM is a feasible and effective treatment for Zenker’s diverticulum, showing optimal rates of technical and clinical success, and resulting in a short hospital stay. This procedure represents a safe and minimally invasive option for patients with ZD, including those with recurrence of symptoms after a previous surgical or endoscopic intervention.