How a unique endoscopic procedure at Hoag gave one patient her life back after a decades-long battle

For 17 years, Roz Hodgins struggled with what many of us take for granted; the ability to comfortably swallow food.

“I always had to be very cognizant of what I was eating and where, and there were foods I loved that I just couldn’t eat,” she said. “Going to a restaurant was difficult because I’d be with a group of friends trying to speak, eat and swallow without coughing. It was challenging.”

Roz was diagnosed with Zenker’s Diverticulum, a condition in which a pouch forms in the back of the throat. Affecting just 2 out of every 100,000 people in the United States, Zenker’s Diverticulum is a digestive disorder that occurs when a muscle, known as the cricopharyngeal muscle, struggles to relax so that food can easily pass into the esophagus after swallowing. The excess pressure buildup eventually causes a pouch to form so that anything consumed—food, pills, liquid—is susceptible to getting stuck inside of it. As more food becomes trapped, the pouch weighs down on the entrance to the esophagus. This diverts more food into the pouch, and the vicious cycle continues. Ensuing symptoms can range from uncomfortable and inconvenient (chronic coughing) to deadly (choking).

“There were a few frightening incidents, one in particular,” she recalled. “I was swallowing some pills before bed and the pills got stuck in the diverticulum. And the Heimlich maneuver does not work in these situations. I was really coughing and gagging, and my only choice was to wait for the pills to dissolve. It was a scary situation for my husband and I.”

Without corrective surgery, the condition usually worsens over time, and surgical options have been limited and invasive—the most common involving a rigid stapler down the throat or a six-inch incision into the neck.

While conducting her own research, Roz discovered a new and effective alternative called Zenker’s Per-Oral Endoscopic Myotomy (Z-POEM), a minimally invasive and incisionless procedure performed by highly specialized gastroenterologists with extensive training in advanced endoscopy. However, finding a physician with the necessary skillset and experience left Roz with few options. Her nationwide search eventually led her to Dr. Kenneth Chang, James & Pamela Muzzy Executive Medical Director Endowed Chair in GI Cancer, Digestive Health Institute, and the first in Southern California to perform the procedure in 2017, with nearly 100 successful cases performed to date.

“Using a technique referred to as third space endoscopy, we pass a thin flexible scope through the mouth, burrow down into the middle layer of the esophagus, and we create this tunnel whereby we are able to precisely expose, cut and release the tight muscle,” said Dr. Chang. “It’s a substantially less invasive way to treat Zenker’s Diverticulum while also resulting in a better outcome for most patients compared to other approaches.”

In September of 2024, Roz underwent the Z-POEM procedure at the Hoag Endoscopy Center in Irvine.

“The recovery was very minimal, like having a sore throat for a day or two,” she said.

Since then, she has been able to safely and comfortably swallow foods she once considered off limits.

“I don’t know what I would have done if not for Dr. Chang. He is just such a visionary. He goes above and beyond for his patients, and he’s given me such an important part of my life back.”