Zenker's Per Oral Endoscopic Myotomy (Z-POEM)
Zenkers Diverticulum
Zenker’s diverticulum is a condition in which a pouch (or pocket) forms in the upper part of the oesophagus, just above the sphincter muscle that opens to allow food to pass into the oesophagus during swallowing. This occurs when the cricopharyngeal muscle—which forms part of the upper oesophageal sphincter—fails to relax properly. As pressure builds during swallowing, a small portion of the inner lining of the throat bulges outward through a weak area in the muscle wall, creating a diverticulum.
Although it is uncommon, Zenker’s diverticulum tends to occur in older adults and can gradually enlarge over time. Patients may experience a variety of symptoms, including difficulty swallowing (dysphagia), regurgitation of undigested food, a sensation of food sticking in the throat, chronic cough, foul breath (halitosis), and sometimes choking episodes or aspiration. Some patients also describe gurgling sounds in the neck after eating or mild discomfort behind the sternum.
Diagnosis is usually made with a barium swallow X-ray or endoscopy, which clearly demonstrates the presence and size of the pouch. Early identification is important, as the condition can impact nutrition, swallowing safety, and quality of life.
Z-POEM procedure
Zenker’s Per-Oral Endoscopic Myotomy (Z-POEM) is a modern, minimally invasive endoscopic treatment for Zenker’s diverticulum. Unlike traditional open or rigid endoscopic surgery, Z-POEM is performed entirely through the mouth using a flexible endoscope - no external cuts or incisions are required.
During the procedure, a small tunnel is created beneath the lining of the upper oesophagus to reach the abnormal muscle (the cricopharyngeal septum) that separates the pouch from the oesophageal lumen. This muscle is then precisely divided, allowing swallowed food to pass smoothly into the oesophagus and preventing it from collecting in the diverticulum.
At Riverview Endoscopy, Dr Niroshan Muwanwella performs Z-POEM using the latest high-definition endoscopic equipment and advanced submucosal dissection techniques. He is one of the few endoscopists in Western Australia with extensive training and experience in third-space endoscopy, including Z-POEM, POEM for achalasia, and G-POEM for gastroparesis.
Most patients experience rapid symptom relief, minimal post-procedure discomfort, and can resume normal eating within 24–48 hours. Z-POEM also allows precise visualisation of the muscle division, reducing the risk of recurrence compared with older approaches.
At Riverview Endoscopy, each case is carefully reviewed in collaboration with anaesthetists and radiology specialists to ensure optimal safety and outcomes.
What to Expect with Z-POEM
Before the procedure:
Patients will have a consultation to review medical history, swallowing symptoms, and previous investigations such as a barium swallow or endoscopy. You’ll receive specific fasting and medication instructions prior to the procedure. Z-POEM is usually performed under general anaesthesia, ensuring you are completely comfortable throughout.
During the procedure:
The endoscope is introduced through the mouth—no incisions are made. A small tunnel is created under the lining of the upper oesophagus, allowing precise access to the abnormal cricopharyngeal muscle. This muscle is carefully divided using advanced electrosurgical instruments, typically taking 30–60 minutes depending on the size of the diverticulum.
After the procedure:
You’ll be observed in hospital, usually for one night, to ensure full recovery and to monitor for any complications such as mild throat discomfort or temporary difficulty swallowing. Most patients can resume a fluid diet the next day and return to normal activities within a few days. Follow-up endoscopy or imaging may be arranged to confirm complete healing and long-term success.
At Riverview Endoscopy, we prioritise patient safety, comfort, and comprehensive aftercare to ensure optimal outcomes following Z-POEM.