Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Mar 16, 2022; 14(3): 183-190
Published online Mar 16, 2022. doi: 10.4253/wjge.v14.i3.183
Z-per-oral endoscopic myotomy as definitive prevention of a bleeding ulcer in Zenker’s diverticulum: A case report
Chonlada Krutsri, Pitichote Hiranyatheb, Preeda Sumritpradit, Pongsasit Singhatas, Pattawia Choikrua
Chonlada Krutsri, Pitichote Hiranyatheb, Preeda Sumritpradit, Pongsasit Singhatas, Pattawia Choikrua, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
Author contributions: Krutsri C and Hiranyatheb P designed, performed and wrote the paper; Sumritpradit P and Singhatas P wrote the paper and analysed the data; Choikrau P contributed analytic tools and analysed the data.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
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Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Pitichote Hiranyatheb, FRCS, MD, Assistant Professor, Surgeon, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ramathibodi Hospital, 270 Praram VI Road, Ratchathewi, Bangkok 10400, Thailand.
Received: October 12, 2021
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.

Keywords: Zenker’s diverticulum, Bleeding Zenker’s diverticulum, Ulcer, Upper gastrointestinal bleed, Peroral endoscopic myotomy for Zenker's diverticulum, Peroral endoscopic myotomy

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.