Toshitaka Hoppo, MD, PhD, Yoshihiro Komatsu, Blair A Jobe. Esophageal & Lung Institute, Allegheny Health Network
Esophageal diverticulum in the mid-esophagus is a rare entity, which accounts for 10-17% of all esophageal diverticula. Myotomy with or without diverticulectomy via thoracoscopy or thoracotomy has been performed for symptomatic patients. We present a case of small mid-esophageal diverticulum, which was successfully treated with targeted peroral endoscopic myotomy (POEM). A 64 year-old female with a past medical history of hypertension, irritable bowel syndrome and gastroesophageal reflux disease, S/P Nissen fundoplication, has had dysphagia in her upper chest area, since she was found to have mid-esophageal diverticulum at the age of 50. She denied any history of pulmonary infectious process, such as Tuberculosis. She denied smoking or alcohol usage. Esophagram demonstrated a 2-cm diverticulum in the mid-esophagus, which seemed to overlie the main bronchus. High-resolution manometry showed normal esophageal motility, although esophageal diverticulum is often associated with esophageal motility disorders. Upper endoscopy demonstrated a small diverticulum located at 24 cm from incisors. There was a thick muscle band with focal strong contraction between diverticulum and esophageal lumen. This muscle band seemed to contribute the development of diverticulum and patient’s symptoms. Therefore, we performed targeted POEM to divide this muscle band. Postoperative course was uneventful. Postoperative esophagram demonstrated an atonic esophagus at the level of diverticulum without leak. Patient was discharged with clear liquid diet on the postoperative day 1. She had complete resolution of dysphagia postoperatively. Six month follow-up upper endoscopy demonstrated a widely patent and atonic esophageal lumen at the level of diverticulum. Targeted POEM is a less-invasive and effective transoral approach to treat small esophageal diverticulum, thus avoiding thoracosopy or thoracotomy. Short myotomy via POEM may be sufficient if there are no manometric findings of esophageal motility disorders. Careful myotomy is critical to prevent accidental injury of adjacent organs, such as bronchus.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78883
Program Number: V063
Presentation Session: Friday Exhibit Hall Video Presentations Session 1 (Non CME)
Presentation Type: EHVideo