Published online Mar 16, 2022. doi: 10.4253/wjge.v14.i3.183
Peer-review started: October 12, 2021
First decision: November 17, 2021
Revised: November 18, 2021
Accepted: February 12, 2022
Article in press: February 12, 2022
Published online: March 16, 2022
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.
Core Tip: Bleeding from ulcers in a Zenker’s diverticulum is extremely rare. Elderly patients with early symptoms of progressive dysphagia should be treated with a high index of suspicion. Risk factors include acidic pills, such as aspirin and non-steroidal anti-inflammatory drugs, that lodge themselves in the diverticulum creating an ulcer, and accumulation of food in the bottom of diverticulum leads to inflammation and subsequent ulcers. Per-oral endoscopic myotomy is a new definitive treatment for Zenker's diverticulum that can promote ulcer healing, decrease recurrent bleeding, and decrease dysphagia.