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Trends in the presentation of patients with esophageal diverticula in the era of endoscopy

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Summary

Background

Esophageal diverticula (ED) mainly consist of epiphrenic (distal) and mid-esophageal diverticula. Most studies describing the presentation of these patients are older and reported a mean age of about 60. We sought to evaluate how two trends—the frequent use of endoscopy and increasing life expectancy—impact the presentation and evaluation of ED patients.

Methods

Charts of ED patients at our facility between 2007 and 2020 were retrospectively reviewed.

Results

A total of 77 ED patients were identified (mean age 76.4 years; 58% female). 59 (77%) were initially diagnosed endoscopically, with an endoscopic prevalence of 0.295%. 44 (57%) were symptomatic at diagnosis, with the most common symptoms being dysphagia (84%) and vomiting/regurgitation (55%). Subjects diagnosed endoscopically were less likely to be symptomatic than those diagnosed radiographically (49% vs. 83%, p = 0.01). Of the 33 asymptomatic subjects, only 2 (6%) developed symptoms during a mean follow-up of 61 months. Six patients (8%) underwent esophageal manometry (all had a motility disorder); five (6%) underwent surgery. Age was not a predictor of the method of diagnosis or presence of symptoms. However, subjects ≥ 80 years old (34, 44%) were less likely to undergo manometry (0% vs. 16%, p = 0.031), with a trend towards being less likely to undergo surgery (0% vs. 14%, p = 0.063).

Conclusion

Nowadays, the majority of ED are endoscopically diagnosed and these are less likely to be symptomatic than radiographically diagnosed ED. ED patients are older than previously reported and older patients are less likely to undergo esophageal manometry or surgery. Gastroenterologists and surgeons should be aware of these emerging trends.

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Authors and Affiliations

  1. The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center, 70300, Zerifin, Israel

    Daniel L Cohen MD, Anton Bermont MD & Haim Shirin MD

  2. Internal Medicine Unit “A” Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel

    Ariel Krutouz MD

Authors
  1. Daniel L Cohen MD
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  2. Ariel Krutouz MD
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  3. Anton Bermont MD
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  4. Haim Shirin MD
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Contributions

All authors contributed to this study. DLC: study concept and design, data acquisition and interpretation, writing the manuscript, critical review. AK: data acquisition and interpretation. AB: data acquisition and interpretation. HS: study concept and design, critical review.

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Correspondence to Daniel L Cohen MD.

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D.L. Cohen, A. Krutouz, A. Bermont, and H. Shirin declare that they have no competing interests.

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Cohen, D.L., Krutouz, A., Bermont, A. et al. Trends in the presentation of patients with esophageal diverticula in the era of endoscopy. Eur Surg 53, 215–221 (2021). https://doi.org/10.1007/s10353-021-00736-6

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  • DOI: https://doi.org/10.1007/s10353-021-00736-6

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