Split Hospital makes major leap in treatment without surgical intervention

(Photo: KBC Split)

SPLIT, 18 June 2026 – The Gastroenterology Department of the Internal Medicine Clinic at the Clinical Hospital Centre Split has successfully performed its first Z-POEM procedure, a technically demanding endoscopic intervention used in the minimally invasive treatment of Zenker’s diverticulum.

The procedure was carried out by Dr Žarko Ardalić and endoscopy nurse Tea Selak, with anaesthetic support led by Dr Antonela Bunoz. The intervention was performed under the mentorship of Prof. Dr Željko Puljiz, head of the Department of Gastroenterology, and Prof. Dr Damir Bonacin.

Zenker’s diverticulum is a pouch-like formation in the back of the throat which can lead to difficulty swallowing, food retention, and potential aspiration into the airway. Although relatively uncommon, it can significantly impact patients’ quality of life.

Z-POEM (Zenker Peroral Endoscopic Myotomy) was first introduced globally in 2016 as a minimally invasive alternative to open surgical treatment. It has since been adopted in specialised centres worldwide due to its significantly shorter recovery time and reduced risk profile.

Previously, the standard treatment involved open neck surgery or rigid endoscopic resection, both of which required longer hospital stays and carried higher risks of complications such as mediastinitis or injury to the recurrent laryngeal nerve.

Compared with traditional surgery, Z-POEM allows for a much quicker recovery. Patients are typically discharged within 24 hours and can return to normal daily functioning shortly after.

A liquid diet is recommended for around ten days following the procedure, after which patients can gradually return to a normal diet.

Prof. Dr Željko Puljiz highlighted the significance of the development, stating that the introduction of Z-POEM confirms the high level of expertise and organisation within the department. He noted that the procedure requires extensive experience, precision, and strong teamwork, offering patients modern, minimally invasive treatment with reduced hospitalisation time.

(Photo: KBC Split)

Head of the Internal Medicine Clinic, Associate Professor Dr Daniela Marasović Krstulović, said the procedure represents an important step forward for the clinic and reflects continuous investment in modern minimally invasive treatment methods.

Dr Žarko Ardalić emphasised the importance of multidisciplinary cooperation, noting that such complex procedures would not be possible without the dedicated work of endoscopy nurses, technicians, and anaesthesiology support teams, as well as high-quality pre- and post-procedural care.

The Gastroenterology Department at KBC Split performs more than 17,000 diagnostic and therapeutic endoscopic procedures annually, positioning it as one of the most active centres of its kind in the region.

The introduction of Z-POEM adds to a growing portfolio of advanced endoscopic techniques already in use, including peroral endoscopic myotomy (POEM) for achalasia, endoscopic submucosal dissection (ESD), and full-thickness resection (FTR) for complex polyps and early gastrointestinal cancers.

Significant progress has also been made in hepatobiliary medicine through the use of cholangioscopy alongside standard ERCP procedures and advanced endoscopic ultrasound-guided interventions.

The interventional gastroenterology team at KBC Split includes Associate Professor Dr Andro Bratanić, Dr Ivan Žaja, Dr Damir Aličić, Dr Antonio Meštrović, Dr Ivan Šustić, and Dr Ante Mayer.

Under the mentorship of Prof. Dr Željko Puljiz and Prof. Dr Damir Bonacin, the team has also become a long-standing host of the “Live Endoscopy” workshops, which regularly bring together international experts in interventional gastroenterology.