Open Zenker’s peroral endoscopic myotomy: a comparative analysis of this modified technique versus the standard Zenker’s peroral endoscopic myotomy approach

Abstract

Background

Open Zenker’s peroral endoscopic myotomy (OZ-POEM) was developed to overcome clinical failures arising from a persistent mucosal flap and difficult closure in Z-POEM. This study compared the outcomes of OZ-POEM and Z-POEM.

Methods

This retrospective study included consecutive patients who underwent Z-POEM (2/2020–12/2022) and OZ-POEM (1/2023–11/2024). The primary outcome was clinical success; secondary outcomes were technical success, adverse events, procedure time, and closure cost.

Results

78 patients were included, 39 per group, with similar baseline characteristics. Clinical success was achieved in 94.9% and 97.4% of patients in the Z-POEM and OZ-POEM groups, respectively. Technical success was 100% in both groups. No clips (US$0) were used with OZ-POEM, whereas a median of 6 clips were used for Z-POEM (P < 0.001), with a median cost of US$580 (interquartile range 485–758.75) (P < 0.001). Median procedure time was shorter in the OZ-POEM group (21 vs. 27 minutes; P < 0.001). One patient in each group suffered a severe adverse event that required repeat endoscopic intervention.

Conclusions

OZ-POEM demonstrated comparable clinical, technical, and safety outcomes to Z-POEM, but with significantly shorter procedure duration and lower closure cost. OZ-POEM is a simplified Z-POEM technique, making it more scalable for trainees and therapeutic endoscopists.

Publication History

Received: 20 July 2025

Accepted after revision: 18 November 2025

Accepted Manuscript online:
18 November 2025

Article published online:
19 January 2026

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