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DOI: 10.1055/s-0034-1390735
Salvage peroral endoscopic myotomy for esophageal diverticulum
Publication History
Publication Date:
20 January 2015 (online)
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Esophageal diverticulum often causes secondary dysmotility. If a diverticulum associated with a functional disorder is growing and exacerbating symptoms, surgical treatment is usually indicated [1] [2]. Peroral endoscopic myotomy (POEM) was introduced by Inoue et al. in 2010 as a novel treatment technique for achalasia [3]. Here, we report our clinical experience of salvage POEM for esophageal diverticulum.
An 84-year-old woman was referred to our hospital with a 30-year history of dysphagia. Endoscopy and esophagography revealed a giant diverticulum in the mid esophagus, into which most of the barium flowed ([Fig. 1], [Fig. 2 a]). The diverticulum compressed the true esophageal lumen, although high resolution manometry (Star Medical Co., Tokyo, Japan) showed no findings of a primary motility disorder ([Fig. 3]). The patient was not suitable for curative surgery, and salvage POEM was undertaken as a less invasive treatment. A posterior wall myotomy (side opposite the diverticulum) was performed longitudinally, from the oral side of the diverticulum to the gastric side, and a pathologic thick layer of muscle was completely resected ([Fig. 4 a, b]). The patient’s subjective dysphagia was markedly decreased, and the smooth passage of barium flow was observed during esophagography ([Fig. 2 b]).
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The most common treatment for esophageal diverticulum is surgical resection. However, the surgical procedure is invasive and often difficult because of factors such as mediastinal adhesion. It also carries a high risk for complications, related mainly to suture leakage. POEM may be an appropriate salvage therapy for esophageal diverticulum in patients who cannot undergo an invasive operation.
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References
- 1 Onwugbufor MT, Obirieze AC, Ortega G et al. Surgical management of esophageal diverticulum: a review of the Nationwide Inpatient Sample database. J Surg Res 2013; 184: 120-125
- 2 Hirano Y, Takeuchi H, Oyama T et al. Minimally invasive surgery for esophageal epiphrenic diverticulum: the results of 133 patients in 25 published series and our experience. Surg Today 2013; 43: 1-7
- 3 Inoue H, Minami H, Kobayashi Y et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 2010; 42: 265-271