Endoscopic foregut surgery and interventions: The future is now. The state-of-the-art and my personal journey

Figure 12 Zenker’s - per-oral endoscopic myotomy procedure in a 91-year-old female with 4-cm Zenker’s diverticulum and dysphagia, including solids, pills, and liquids. A: Pre- Zenker’s - per-oral endoscopic myotomy procedure (Z-POEM) esophagram showing 4.3 cm Zenker’s; B: Septum identified, with diverticulum on left, and esophageal lumen on right; C: Start of mucosal incision (horizontal) over the septum; D: Mucosal incision completed with exposure of cricopharyngeus muscle (CPM); E: Submucosal tunnel on each side of the CPM; F: Near completion of myotomy; G: Mucosal closure with 5 clips; H: Follow-up esophagram 2 mo post Z-POEM, contrast flows freely, and patient has complete resolution of dysphagia.