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CC BY 4.0 · Endoscopy 2023; 55(S 01): E918-E919
DOI: 10.1055/a-2107-2287
E-Videos

Diverticular peroral endoscopic myotomy: management of a complex epiphrenic diverticulum

Abdelazeez Gaber
Integrated Clinical and Research Center for Intestinal Disorders (ICRID), Gastroenterology Division, Endemic Medicine Department, Cairo University, Cairo, Egypt
,
Ismail Fadloon
Integrated Clinical and Research Center for Intestinal Disorders (ICRID), Gastroenterology Division, Endemic Medicine Department, Cairo University, Cairo, Egypt
,
Hany Shehab 
Integrated Clinical and Research Center for Intestinal Disorders (ICRID), Gastroenterology Division, Endemic Medicine Department, Cairo University, Cairo, Egypt
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Epiphrenic diverticula are a rare entity presenting with dysphagia and vomiting in most cases. Conventional treatment usually involves complex thoracic surgeries with considerable morbidity, especially as the condition usually affects elderly patients. The overall mortality rate for surgical management of epiphrenic diverticula is about 5 %, with morbidity rate as high as 20 % [1]. A few case reports and case series have shown successful endoscopic management of epiphrenic diverticula by endoscopic septotomy (DPOEM) [2] [3]. In this video we describe a case of a large complex epiphrenic diverticulum in a 78-year-old man presenting with long-standing dysphagia and vomiting ([Video 1]).

Video 1 Diverticular peroral endoscopic myotomy procedure to achieve septotomy in a large epiphrenic diverticulum.


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A submucosal tunnel was created 5 cm above the diverticular septum. After reaching and exposing the septum, the tunnel was then extended laterally about 2 cm in the base of the diverticulum and medially down the esophageal aspect reaching 1 cm below the cardia ([Fig. 1]). A full-thickness myotomy was then performed extending through the septum and down to involve the cardia (HybridKnife – Erbe VIO 3 generator with ERBEJET; mucosal incision and myotomy – Endocut Q 2:3:3; submucosal dissection – Precisect effect 4.5; Erbe Elektromedizin GmbH, Tübingen, Germany). Recovery was uneventful, and an oral diet was commenced after 24 hours. At the 3-month follow-up, symptoms of dysphagia and vomiting had completely resolved.

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Fig. 1 Exposure of the diverticular septum after submucosal tunneling.

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Competing interests

The authors declare that they have no conflict of interest.

  • References

  • 1 Smith CD. Esophageal strictures and diverticula. Surg Clin North Am 2015; 95: 669-681
    CrossrefPubMedSearch in Google Scholar
  • 2 Yang J, Zeng X, Yuan X. et al. An international study on the use of peroral endoscopic myotomy (POEM) in the management of esophageal diverticula: the first multicenter D-POEM experience. Endoscopy 2019; 51: 346-349
    Thieme ConnectPubMedSearch in Google Scholar
  • 3 Sato H, Takeuchi M, Hashimoto S. et al. Esophageal diverticulum: new perspectives in the era of minimally invasive endoscopic treatment. World J Gastroenterol 2019; 25: 1457-1464
    CrossrefPubMedSearch in Google Scholar

Corresponding author

Hany Shehab, MD
Endemic Medicine Department
Integrated Clinical and Research Center for Intestinal Disorders (ICRID)
Abdulazeez Al-Saud St.
Manial, Cairo 11562
Egypt   

Publication History

Article published online:
13 July 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Smith CD. Esophageal strictures and diverticula. Surg Clin North Am 2015; 95: 669-681
    CrossrefPubMedSearch in Google Scholar
  • 2 Yang J, Zeng X, Yuan X. et al. An international study on the use of peroral endoscopic myotomy (POEM) in the management of esophageal diverticula: the first multicenter D-POEM experience. Endoscopy 2019; 51: 346-349
    Thieme ConnectPubMedSearch in Google Scholar
  • 3 Sato H, Takeuchi M, Hashimoto S. et al. Esophageal diverticulum: new perspectives in the era of minimally invasive endoscopic treatment. World J Gastroenterol 2019; 25: 1457-1464
    CrossrefPubMedSearch in Google Scholar

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Zoom Image
Fig. 1 Exposure of the diverticular septum after submucosal tunneling.