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

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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References

  1. 1.

    Thomas ML, Anthony AA, Fosh BG, et al. Oesophageal diverticula. Br J Surg. 2001;88(5):629–42.

    CAS  Article  Google Scholar 

  2. 2.

    Sonbare DJ. Pulsion diverticulum of the oesophagus: more than just an out pouch. Indian J Surg. 2015;77(1):44–8.

    Article  Google Scholar 

  3. 3.

    Baker ME, Zuccaro G Jr, Achkar E, et al. Esophageal diverticula: patient assessment. Semin Thorac Cardiovasc Surg. 1999;11(4):326–36.

    CAS  Article  Google Scholar 

  4. 4.

    Nehra D, Lord RV, DeMeester TR, et al. Physiologic basis for the treatment of epiphrenic diverticulum. Ann Surg. 2002;235(3):346–54.

    Article  Google Scholar 

  5. 5.

    do Nascimento FA, Lemme EM, Costa MM. Esophageal diverticula: pathogenesis, clinical aspects, and natural history. Dysphagia. 2006;21(3):198–205.

    Article  Google Scholar 

  6. 6.

    Charlson ME, Pompei P, Ales KL, al at. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.

    CAS  Article  Google Scholar 

  7. 7.

    Charlson Comorbidity Index (CCI).. https://www.mdcalc.com/charlson-comorbidity-index-cci. Accessed 20 Apr 2021.

  8. 8.

    Harrington SW. The surgical treatment of pulsion diverticula of the thoracic esophagus. Ann Surg. 1949;129(5):606–18.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Habein HC, Moersch HJ, Kirklin JW. Diverticula of the lower part of the esophagus; a clinical study of one hundred forty-nine nonsurgical cases. AMA Arch Intern Med. 1956;97(6):768–77.

    Article  Google Scholar 

  10. 10.

    Habein HC, Kirklin JW, Clagett OT, et al. Surgical treatment of lower esophageal pulsion diverticula. AMA Arch Surg. 1956;72(6):1018–24.

    Article  Google Scholar 

  11. 11.

    Effler DB, Barr D, Groves LK. Epiphrenic diverticulum of the esophagus: surgical treatment. Arch Surg. 1959;79:459–67.

    CAS  Article  Google Scholar 

  12. 12.

    Bruggeman LL, Seaman WB. Epiphrenic diverticula. An analysis of 80 cases. Am J Roentgenol Radium Ther Nucl Med. 1973;119(2):266–76.

    CAS  Article  Google Scholar 

  13. 13.

    Kaye MD. Oesophageal motor dysfunction in patients with diverticula of the mid-thoracic oesophagus. Thorax. 1974;29(6):666–72.

    CAS  Article  Google Scholar 

  14. 14.

    Giuli R, Estenne B, Richard CA, et al. Les diverticules de l’oesophage. A propos de 221 cas [Esophageal diverticula. Apropos of 221 cases]. Ann Chir. 1974;28(6):435–43. French.

    CAS  PubMed  Google Scholar 

  15. 15.

    Debas HT, Payne WS, Cameron AJ, et al. Physiopathology of lower esophageal diverticulum and its implications for treatment. Surg Gynecol Obstet. 1980;151(5):593–600.

    CAS  PubMed  Google Scholar 

  16. 16.

    Rivkin L, Bremner CG, Bremner CH. Pathophysiology of mid-oesophageal and epiphrenic diverticula of the oesophagus. S Afr Med J. 1984;66(4):127–9.

    CAS  PubMed  Google Scholar 

  17. 17.

    Evander A, Little AG, Ferguson MK, et al. Diverticula of the mid- and lower esophagus: pathogenesis and surgical management. World J Surg. 1986;10(5):820–8.

    CAS  Article  Google Scholar 

  18. 18.

    Fékéte F, Vonns C. Surgical management of esophageal thoracic diverticula. Hepatogastroenterology. 1992;39(2):97–9.

    PubMed  Google Scholar 

  19. 19.

    Altorki NK, Sunagawa M, Skinner DB. Thoracic esophageal diverticula. Why is operation necessary? J Thorac Cardiovasc Surg. 1993;105(2):260–4.

    CAS  Article  Google Scholar 

  20. 20.

    Benacci JC, Deschamps C, Trastek VF, et al. Epiphrenic diverticulum: results of surgical treatment. Ann Thorac Surg. 1993;55(5):1109–13. discussion 1114.

    CAS  Article  Google Scholar 

  21. 21.

    Hudspeth DA, Thorne MT, Conroy R, et al. Management of epiphrenic esophageal diverticula. A fifteen-year experience. Am Surg. 1993;59(1):40–2.

    CAS  PubMed  Google Scholar 

  22. 22.

    Castrucci G, Porziella V, Granone PL, et al. Tailored surgery for esophageal body diverticula. Eur J Cardiothorac Surg. 1998;14(4):380–7.

    CAS  Article  Google Scholar 

  23. 23.

    Jordan PH, Kinner BM. New look at epiphrenic diverticula. World J Surg. 1999;23(2):147–52.

    Article  Google Scholar 

  24. 24.

    Fasano NC, Levine MS, Rubesin SE, et al. Epiphrenic diverticulum: clinical and radiographic findings in 27 patients. Dysphagia. 2003;18(1):9–15.

    Article  Google Scholar 

  25. 25.

    Klaus A, Hinder RA, Swain J, et al. Management of epiphrenic diverticula. J Gastrointest Surg. 2003;7(7):906–11.

    Article  Google Scholar 

  26. 26.

    Tedesco P, Fisichella PM, Way LW, et al. Cause and treatment of epiphrenic diverticula. Am J Surg. 2005;190(6):891–4.

    Article  Google Scholar 

  27. 27.

    Zaninotto G, Portale G, Costantini M, et al. Long-term outcome of operated and unoperated epiphrenic diverticula. J Gastrointest Surg. 2008;12(9):1485–90.

    Article  Google Scholar 

  28. 28.

    McDonald JD, Jacobs J, Saad A, et al. Heller myotomy for epiphrenic diverticula compared to nondiverticula esophageal motility disorders, a single institution experience and appraisal of patient characteristics, high-resolution manometry and outcomes. Dig Surg. 2020;37(1):72–80.

    Article  Google Scholar 

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Authors

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.

Corresponding author

Correspondence to Daniel L Cohen MD.

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Conflict of interest

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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Keywords

  • Esophageal diverticulum
  • Signs and symptoms
  • Endoscopy
  • Esophageal motility disorders
  • Manometry