Epiphrenic and Mid-Esophageal Diverticula

Abstract

Epiphrenic and mid-esophageal diverticula are rare pathologic esophageal diseases. Though they are located in different regions on the esophagus, both pathologic processes are inherently related to esophageal dysmotility. The majority of patients are asymptomatic, and many of these diverticula are diagnosed incidentally on imaging. All symptomatic patients should undergo treatment, and there is growing evidence that treatment should be offered to asymptomatic patients. Ultimately, the treatment for esophageal diverticula is surgical resection and treatment of the underlying dysmotility. The tenets of epiphrenic diverticular surgical treatment are to treat the diverticulum, perform a myotomy, and perform an anti-reflux procedure on the esophagus. Epiphrenic diverticula can be approached laparoscopically or thoracoscopically depending on size and location. The treatment goals for mid-esophageal diverticula are to treat the diverticulum, identify and resect any fistula, and treat the underlying motility disorder. These diverticula are generally approached thoracoscopically, though there are emerging endoscopic treatment modalities that are safe and effective.