Abstract
Diverticula of the thoracic esophagus (ED) are rare. The main symptoms are regurgitation and dysphagia, and sometimes respiratory symptoms too. The literature is unable to provide a high level of evidence because it consists mainly of case series or case reports. Although a linear correlation between symptoms and the size of ED has not been firmly demonstrated, it is clinically common to find that larger diverticula are more symptomatic. Some studies have found that ED patients with mild or no symptoms do not experience any worsening of their symptoms with time, whereas moderately or severely symptomatic patients tend to progress. Surgery (completed via a minimally invasive access nowadays) has achieved high success rates with extremely low rates of recurrence, but it is burdened by a far from negligible incidence of complications, particularly relating to suture line leakage. Surgery is consequently only justified in symptomatic patients, reserving a conservative approach to asymptomatic or minimally-symptomatic cases, which involves a clinical follow-up and the prescription of proton pump inhibitors or endoscopic pneumatic dilation.
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References
Jordan PH, Kinner BM. New look at epiphrenic diverticula. World J Surg. 1999;23(2):147–52.
Wheeler D. Diverticula of the foregut. Radiology. 1947;49:476–81.
Dobashi Y, Goseki N, Inutake Y, Kawano T, Endou M, Nemoto T. Giant epiphrenic diverticulum with achalasia occurring 20 years after Heller’s operation. J Gastroenterol. 1996;31:844–7.
Schima W, Schober E, Stacher G, Franz P, Uranitsch K, Pokieser P, et al. Association of midoesophageal diverticula with oesophageal motor disorders. Videofluoroscopy and manometry. Acta Radiol. 1997;38:108–14.
Altorki NK, Sunagawa M, Skinner DB. Thoracic esophageal diverticula. Why is operation necessary? J Thorac Cardiovasc Surg. 1993;105:260–5.
Benacci JC, Deschamps C, Trastek VF, Allen MS, Daly RC, Pairolero PC. Epiphrenic diverticulum: results of surgical treatment. Ann Thorac Surg. 1993;55:1109–014.
Castrucci G, Porziella V, Granone PL, Picciocchi A. Tailored surgery for esophageal body diverticula. Eur J Cardiothorac Surg. 1998;14:380–7.
Streitz Jr JM, Glick ME, Ellis Jr FH. Selective use of myotomy for treatment of epiphrenic diverticula. Manometric and clinical analysis. Arch Surg. 1992;127:585–7.
Fasano NC, Levine MS, Rubesin SE, Redfern RO, Laufer I. Epiphrenic diverticulum: clinical and radiographic findings in 27 patients. Dysphagia. 2003;18:9–15.
Hung JJ, Hsieh CC, Lin SC, Wang LS. Squamous cell carcinoma in a large epiphrenic esophageal diverticulum. Dig Dis Sci. 2009;54:1365–8.
Herbella FAM, Del Grande JC. Benign esophagopulmonary fistula through an epiphrenic diverticulum and asymptomatic achalasia. Dig Dis Sci. 2010;55:1177–8.
Lee JH, Chae HS, Kim KH, Kim JW, Wang YP, Lee SH, et al. Delayed primary repair of perforated epiphrenic diverticulum. J Korean Med Sci. 2004;19:887–90.
Thomas ML, Anthony AA, Fosh BG, Finch JG, Maddern GJ. Oesophageal diverticula. Br J Surg. 2001;88:629–42.
Zaninotto G, Portale G, Costantini M, Zanatta L, Salvador R, Ruol A. Therapeutic strategies for epiphrenic diverticula: systematic review. World J Surg. 2011;35(7):1447–53.
Nehra D, Lord RV, DeMeester TR, Theisen J, Peters JH, Crookes PF, et al. Physiologic basis for the treatment of epiphrenic diverticulum. Ann Surg. 2002;235(3):346–54.
Klaus A, Hinder RA, Swain J, Achem SR. Management of epiphrenic diverticula. J Gastrointest Surg. 2003;7(7):906–11.
Del Genio A, Rossetti G, Maffetton V, Renzi A, Brusciano L, Limongelli P, et al. Laparoscopic approach in the treatment of epiphrenic diverticula: long-term results. Surg Endosc. 2004;18:741–5.
Fernando HC, Luketich JD, Samphire J, Alvelo-Rivera M, Christie NA, Buenaventura PO, et al. Minimally invasive operation for esophageal diverticula. Ann Thorac Surg. 2005;80:2076–81.
Melman L, Quinlan J, Robertson B, Brunt LM, Halpin VJ, Eagon JC, et al. Esophageal manometric characteristics and outcome for laparoscopic esophageal diverticulectomy, myotomy and partial fundoplication for epiphrenic diverticula. Surg Endosc. 2009;23:1337–41.
Zaninotto G, Parise P, Salvador R, Costantini M, Zanatta L, Rella A, et al. Laparoscopic repair of epiphrenic diverticulum. Semin Thorac Cardiovasc Surg. 2012;24(3):218–22.
Fumagalli Romario U, Ceolin M, Porta M, Rosati R. Laparoscopic repair of epiphrenic diverticulum. Semin Thorac Cardiovasc Surg. 2012;24(3):213–7.
Hirano Y, Takeuchi H, Oyama T, Saikawa Y, Niihara M, Sako H, et al. Minimally invasive surgery for esophageal epiphrenic diverticulum: the results of 133 patients in 25 published series and our experience. Surg Today. 2013;43(1):1–7.
Zaninotto G, Rizzetto C, Zambon P, Guzzinati S, Finotti E, Costantini M, et al. Long-term outcome of operated and unoperated epiphrenic diverticula. J Gastrointest Surg. 2008;12:1485–90.
Orringer MB. Epiphrenic diverticula: fact and fable. Ann Thorac Surg. 1993;55:1067–8.
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Paolo, P., Giovanni, Z. (2014). Surgery for Minimally Symptomatic Pulsion Diverticula of the Thoracic Esophagus. In: Ferguson, M. (eds) Difficult Decisions in Thoracic Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach, vol 1. Springer, London. https://doi.org/10.1007/978-1-4471-6404-3_35
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DOI: https://doi.org/10.1007/978-1-4471-6404-3_35
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