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An epiphrenic diverticulum is a pulsion-type false diverticulum, occurring in the distal 10 cm of the esophagus where the mucosal and submucosal tissue layers herniate through a weakness in the muscularis layer of the esophagus [[2]]. Given the diverticula and motility abnormalities, it was not clear whether LES peroral endoscopic myotomy (POEM) alone would improve her symptoms, or whether combined POEM (LES myotomy and septotomy) would be needed. Treating the underlying motor disorder (i.e., hypertensive LES creating high-pressure segment, contributing to the diverticula) by performing a myotomy in conjunction with the diverticulectomy is fundamental to the treatment of epiphrenic diverticula, as opposed to patients being treated with diverticulectomy alone [[8]]. [Extracted from the article]

B Video 1 b A symptomatic 71-year-old man with post-surgical fibrosis underwent peroral endoscopic myotomy for Zenker's diverticulum (Z-POEM) using a hybrid approach. 10-1055-a-1164-7569-1551evv01.mp4 The procedure was continued using the Z-POEM technique to ensure complete exposure and dissection of the septum. [Extracted from the article]