Esophageal Diverticulum

Abstract

An esophageal diverticulum is rare and is usually asymptomatic, although this condition may cause dysphagia, regurgitation, chest pain, globus, halitosis, and aspiration pneumonia. Based on its location and the characteristic pathophysiology associated with this anomaly, esophageal diverticula are classified into the following types: Zenker’s, epiphrenic, and mid-esophageal diverticula (Rokitansky diverticulum). Esophagography is useful to diagnose esophageal diverticula. Evaluation of accompanying esophageal motility disorders, including achalasia and distal esophageal spasm is essential in patients with epiphrenic diverticula. Appropriate treatment is important for management of symptomatic esophageal diverticula. Previously, diverticulectomy or diverticulopexy was the usual treatment for this condition. However, surgical resection of diverticula is challenging owing to the complex esophageal anatomy, particularly in patients with diverticula located in close proximity to the oral cavity. Technological advances have led to the introduction of minimally invasive endoscopic approaches focused on symptom improvement. Rigid diverticuloscope-assisted septotomy, flexible endoscopic septum division, Zenker peroral endoscopic myotomy (Z-POEM), and peroral endoscopic septotomy (POES) are useful for treatment of a Zenker’s diverticulum. Recent studies recommend diverticulum peroral endoscopic myotomy (D-POEM) for endoscopic management of epiphrenic diverticula. Further studies are warranted to conclusively establish the technical success rates, clinical symptom improvement, and long-term prognosis of Z-POEM, POES, and D-POEM.