Epiphrenic diverticula: An added source of complexity in achalasia management

Holmes, Ian; Ko, Marcia G.; Kouanda, Abdul; Singh, Aparajita; Nett, Andrew; Kathpalia, Priya

doi:10.1111/nmo.13761

Cited by 2 publications

(3 citation statements)

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“…No difference in perioperative complications in patients with and without epiphrenic diverticula was observed [8]. Further, only small case series and case reports are published that concluded that POEM without diverticulotomy was safe and effective as treatment for patients with an esophageal diverticulum [17][18][19][20][21][22][23][24][25][26].…”

Section: Discussionmentioning

confidence: 99%

“…To date, only a small number of studies have investigated the efficacy and safety of POEM without diverticulotomy in patients with esophageal diverticula and are limited by the number of included patients [17][18][19][20][21][22][23][24][25][26]. The largest study thus far with fourteen patients showed a decrease in Eckardt score after POEM.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of peroral endoscopic myotomy for esophageal diverticula

et al. 2023

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Background Epiphrenic diverticula are rare and mainly occur in patients with underlying esophageal motility disorders. The current standard treatment is surgical diverticulectomy often combined with myotomy and is associated with significant adverse event rates. The aim of this study is to examine the efficacy and safety of peroral endoscopic myotomy in reducing esophageal symptoms in patients with esophageal diverticula. Methods We performed a retrospective cohort study including patients with an esophageal diverticulum who underwent POEM between October 2014 and December 2022. After informed consent, data was extracted from medical records and patients completed a survey by telephone. Primary outcome was treatment success, defined as Eckardt score below four with a minimal reduction of two points. Results Seventeen patients (mean age 71 years, 41.2% female) were included. Achalasia was confirmed in 13 patients (13/17, 76.5%), Jackhammer esophagus in two patients (2/17, 11.8%), diffuse esophageal spasm in one patient (1/17, 5.9%) and in one patient no esophageal motility disorder was found (1/17, 5.9%). Treatment success was 68.8% and only one patient (6.3%) underwent retreatment (pneumatic dilatation). Median Eckardt scores decreased from seven to one after POEM (p < 0.001). Mean size of the diverticula decreased from 3.6 cm to 2.9 cm after POEM (p < 0.001). Clinical admission was one night for all patients. Adverse events occurred in two patients (11.8%) which were classified as grade II and IIIa (AGREE classification). Conclusion POEM is effective and safe to treat patients with esophageal diverticula and an underlying esophageal motility disorder.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of peroral endoscopic myotomy for esophageal diverticula

et al. 2023

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“…The low recurrence rate of our study may be associated with a shorter follow-up period and consolidated definitions of recurrence. Epiphrenic diverticula are commonly associated with esophageal motility disorders, so the management of epiphrenic diverticula requires addressing the underlying motility disorders; otherwise, the diverticula may recur after diverticulectomy [31]. It is considered that in patients with epiphrenic diverticulum with esophageal motility disorders, POEM through the gastroesophageal junction may pose a higher risk of gastroesophageal reflux than laparoscopic myotomy with fundoplication [32].…”

Section: Discussionmentioning

confidence: 99%

Peroral endoscopic myotomy treatment for symptomatic esophageal diverticulum: a systematic review and meta-analysis

Ren

Xie

Shrestha

et al. 2021

European Journal of Gastroenterology &Amp; Hepatology

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Peroral endoscopic myotomy (POEM) is a rapidly evolving technique for the treatment of esophageal diverticulum. The aim of this study was to perform a systematic review and meta-analysis of the literature focusing on POEM for symptomatic esophageal diverticula, including an in-depth evaluation of its efficacy, safety, and limitations. A comprehensive literature search was completed to identify articles that examined the efficacy and safety of POEM for esophageal diverticula. Heterogeneity among studies was assessed using the I 2 statistic. Meta-regression and sensitivity analyses were performed to explore the sources of heterogeneity and assess potentially important covariates influencing the main outcomes. Primary endpoints such as rates of success, adverse events, and recurrences were evaluated. P values of ≤0.05 were considered statistically significant. Nine studies with a total of 153 patients were enrolled. Pooled technical success, clinical success, adverse events, and recurrence rates were 99% [95% confidence interval (CI), 97-100%; I 2 = 0%), 94% (95% CI, 89-97%; I 2 = 24%), 2% (95% CI, 0-6%, I 2 = 0%), and 0% (95% CI, 0-1%; I 2 = 0%), respectively. The pooled perforation rate was 6% (95% CI, 1-11%; I 2 = 0%). Meta-regression analysis indicated that esophageal diverticula types and motility disorders were not associated with the clinical success rate (P > 0.05). POEM is a feasible, safe, and effective treatment for symptomatic esophageal diverticula, with low adverse events and recurrence rates.

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Epiphrenic diverticula: An added source of complexity in achalasia management

Cited by 2 publications

References 20 publications

Efficacy and safety of peroral endoscopic myotomy for esophageal diverticula

Efficacy and safety of peroral endoscopic myotomy for esophageal diverticula

Peroral endoscopic myotomy treatment for symptomatic esophageal diverticulum: a systematic review and meta-analysis

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