Esophageal intramural pseudodiverticulosis (EIPD) is a rare disease characterized by small, ephiteliallined, outpouchings from the esophageal wall. The predominant symptom is dysphagia, chest pain and presents as acute food impaction. Treatment includes medications for inflammation or endoscopic dilatation of the esophagus. We present a novel treatment of symptomatic esophageal pseudodiverticulosis using a fully covered self expanding metal stent placement, anchored in place with an endoscopic suturing system. A 68-year-old African-American male with multiple co-morbid conditions presented to the hospital with chest pain. During the hospitalization he was noted to have chronic dysphagia, and recurrent pneumonia. A barium esophagram showed severe dysmotility and irregularity in the esophagus and evidence of aspiration. An upper endoscopy revealed multiple pseudodiverticulosis with small and large openings in the middle and lower third of the esophagus. There were areas where food was impacted within these diverticula; which was cleared. Due to his ongoing symptoms and severity of the pseudodiverticulosis, further treatment was requested. An 18 mm by 120 mm fully covered self expanding esophageal metal stent was successfully placed and then using an endoscopic suturing system the stent was anchored in place. EIPD histologically, excretory ducts described as squamous-lined dilated ducts of deep mucosal esophageal glands, often surrounded by chronic inflammation. Candida albicans infection is frequently present in EIPD, and it can contribute to the exacerbation of the disease. EIPD is related to diabetes mellitus, esophageal candidiasis, chronic alcohol consumption, GERD, achalasia, other esophageal motility disorders, and cancer. Other symptoms resemble GERD, odynophagia, food impaction, anorexia, chest pain. Besides strictures, complications include progressive stenosis, esophageal candidiasis, herpetic infection, food impaction, bleeding, trachea-esophageal fistula, mediastinal abscess, and spontaneous perforation.Figure 1Figure 2Current management of EIPD includes esophageal dilatation, sometimes repeatedly. Other measures have included calcium-channel blockers, esophagomyotomy, or even esophagectomy. There have been no reports of the use of esophageal stents for the treatment of EIPD in the literature. The case presented proposes a new alternative solution for EIPD, for the relieving of symptoms, without repeated endoscopic procedures or long term medications.
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Sep 1, 2017
S Law + 3
Open Access