Z-per-oral endoscopic myotomy as definitive prevention of a bleeding ulcer in Zenker's diverticulum: A case report

Bleeding from Zenker's diverticulum is extremely rare. At present, there are no guidelines for the management of bleeding Zenker's diverticulum because of its rarity. Per-oral endoscopic myotomy (Z-POEM) is a precision myotomy technique and minimally invasive procedure for the treatment of Zenker's diverticulum. We present a systematic review and a rare case of bleeding Zenker's diverticulum that was effectively treated using Z-POEM. A 72-year-old presented after 3 d of hematemesis. He had a 2-year history of progressive dysphagia and reported no antiplatelet, anticoagulant, or non-steroidal anti-inflammatory drug use. His vital signs were stable, and the hematocrit was 36%. Previous gastroscopy and barium swallow had revealed Zenker's diverticulum before the bleeding occurred. We performed gastroscopy and found a 5-mm ulcer with a minimal blood clot and spontaneously resolved bleeding. Z-POEM for definitive treatment was performed to reduce accumulation of food and promote ulcer healing. He had no complications and no bleeding; at the follow-up 6 mo later, the ulcer was healed. Z-POEM can be definitive prevention for bleeding ulcer in Zenker's diverticulum that promotes ulcer healing, reducing the risk of recurrent bleeding. Z-POEM is also a definitive endoscopic surgery for treatment of Zenker's diverticulum.