DOI: https://doi.org/10.36347/sjmcr.2026.v14i05.075

Pages: 1183-1187

Zenker diverticulum is a rare condition caused by dysfunction of the cricopharyngeal muscle, leading to progressive dysphagia and regurgitation. Endoscopic approaches, particularly Zenker per-oral endoscopic myotomy (Z-POEM), have emerged as effective minimally invasive treatments. However, giant diverticula remain technically challenging. We report the case of a 72-year-old man with a giant Zenker diverticulum measuring 110 mm, successfully treated using a modified Z-POEM technique. The procedure included bilateral submucosal injection, extended septal myotomy, additional distal fiber sectioning, and transverse clip closure of the mucosal defect. The intervention was completed without complications, and the patient experienced complete resolution of symptoms with an uneventful recovery. Modified Z-POEM may represent a valuable technical adaptation for the management of a giant Zenker diverticula, although further studies are required to validate its safety and long-term efficacy.