Su1626 Surgical Management of Esophageal Perforation: A 10-Year Experience

Abstract

Aim: The objective of this study was to evaluate high-resolution impedance manometry (HRIM) findings in patients with esophageal epiphrenic diverticulum. Methods: Patients with esophageal epiphrenic diverticulum who underwent HRIM between October 2008 and March 2012 are included in the study. Manometric findings were compared to endoscopic (EGD) and barium swallow (BS) findings. Patients with previous foregut surgery were excluded. Results: Six patients (mean age 59.0 years, 3 females) are included in the study. On EGD the diverticulum was 1 to 4 cm above the gastro-esophageal junction (GEJ) and the mouth of diverticulum was 2 to 9 cm in size. Mean lower esophageal sphincter pressure (LESP) and mean Integrated relaxation pressure (IRP) were 50.7 mmHg (range 39.2 to 61.9 mmHg) and 22.4 mmHg (range 13.8 to 30.8 mmHg) respectively. Achalasia was the most common abnormality noted in 3 patients (type I=2 and type II=1). Two additional patients had isolated EGJ obstruction with preserved esophageal motility. One patient had normal IRP but weak peristalsis. A break in peristalsis corresponding to themouth of the diverticulum could be seen in 4 patients. There was decreased bolus transit in three patients. Conclusions: There is a high prevalence of esophageal outflow obstruction and primary peristaltic abnormality in patients with epiphrenic diverticulum. This reconfirms the need to extend the myotomy down on to the GEJ even in patients in whom the diverticulum appears to be well above the GEJ.