Narrow Band Imaging (NBI) Enhancing the Visualization of Diverticula in a Rare Case of Esophageal Intramural Pseudodiverticulosis with Esophageal Strictures

Abstract

Purpose: Introduction: Esophageal Intramural Pseudodiverticulosis (EIP) are abnormal dilated ducts of submucosal glands often associated with conditions that cause chronic esophageal inflammation such as gastroesophageal reflux, chronic candidiasis, previous caustic ingestion and esophageal cancer. EIP is most commonly seen in the sixth or seventh decade of age. Methods: Case: A 56-year-old caucasian woman diagnosed with EIP in 1990 and submitted to esophageal dilation every 2 years in average due to intermittent dysphagia presents with new onset of upper esophageal discomfort pointed at the level of the thyroid cartilage. Previous barium-contrast esophagogram showed a diffuse narrowed esophagus and multiple flask-shaped outpouchings in the esophageal wall. Results: Endoscopy was performed and revealed two areas of circumferential stenosis at 20 cm and 37 cm from incisors associated with multiple small diverticula in the esophageal wall. Initially a white lamp examination was performed then NBI system was applied and a considerable enhancement of the diverticula images was observed with a better appreciation of the disease extension throughout the esophagus. We choose to approach the double stenosis with a guidewire Savary dilation using a 36 Fr probe. Patient's symptoms improved considerably 2 days after the procedure. Conclusion: Discussion: EIP is a rare condition with only about 200 cases reported although autopsy studies showed its incidence being as high as 55%. The endoscopic appearance of EIP is characteristic but the diverticula openings are small and often missed. Our report shows that NBI might be a helpful tool in the endoscopic armamentarium for diagnosis of this condition.Figure: Esophageal Pseudodiverticulosis using white light.Figure: Esophageal Pseudododiverticulosis using Narrow Band Imaging.