Flexible Endoscopic Treatment of Esophageal Diverticulum: A Case Report

BackgroundIn the past, surgical resection was the only treatment available for esophageal diverticulum. Minimally invasive endoscopic treatment of esophageal diverticulum has become more and more popular in recent years. We reported a case of transoral endoscopic resection of esophageal diverticulum and crestectomy, which had a similar effect to surgery and retained the physiological function of the esophagus. It has the advantages of short procedure time, short hospital stay, and good long-term prognosis.Case presentationA 67-year-old gentleman presented with persistent dysphagia and repeated nausea and vomiting for 2 years. Combined with chest CT, barium esophagography and esophagogastroduodenoscopy, the diagnosis was a mid-esophageal diverticulum. After discussion and communication, the patient underwent oral endoscopic esophageal diverticulectomy. During the operation, the weak area of the bottom muscle layer of the diverticulum was completely removed, and the crest of the diverticulum was cut off, and the kiss suture was performed with titanium clips to reduce tension. After the operation, the right pleural effusion occurred and the lung infection was aggravated, and the right pleural drainage tube was placed to relieve the symptoms. An 18*100mm fully covered metal stent was placed under a gastroscope. Place the duodenal nutrition tube and the gastric tube drainage tube for vacuum suction. After a long period of fasting, enteral nutrition support, adequate postoperative drainage treatment and antibiotic treatment eventually l resulted in full recovery without recurrence.ConclusionThe selection of treatment for esophageal diverticulum needs to refer to many factors. For the middle esophageal diverticulum, especially those with large diverticulum sac and small mouth, and those who have indications for surgery, in addition to selective surgery and conventional endoscopic surgery, you can also try endoscopic diverticulectomy and crestectomy.

518 DIVERTICULECTOMY WITH EXTENDED MIOTOMY FOR TREATMENT OF ESOPHAGEAL INTRATHORACIC DIVERTICULUM

The treatment of thoracic esophageal diverticulum is based on removing the diverticulum and treating the possible cause that gave rise to it. We associate a myotomy below the area of the diverticulum to treat any difficulty in emptying and decrease the esophageal pressure that may have led to the diverticulum. Methods We show a video how to manage the esophagel diverticulum. Results We show a video how to manage the esophagel diverticulum. Conclusion The diverticulectomy should be associated with an extended miotomy. Video https://www.dropbox.com/s/c1m2r0ic4mw4cb5/Bianchi%20ET%20-%20diverticulectomy.mp4?dl=0.

Aortoesophageal Fistula Secondary to Esophageal Diverticulum Resulting in Sudden Unexpected Death

Aortoesophageal fistula (AEF) is a rarely encountered clinical outcome that is often fatal. It is most commonly a postoperative complication of vascular surgery (secondary AEF). Reported primary causes of AEF include aortic aneurysm, atherosclerosis, infection, foreign objects, achalasia with megaesophagus, gastrointestinal malignancy, and radiotherapy. Aortoesophageal fistula is often not a top diagnostic consideration for clinicians or pathologists and has the potential to be overlooked. This report describes a rare case of AEF secondary to an esophageal traction diverticulum and associated abscess that resulted in the sudden unexpected death of a 78-year-old male. Aortoesophageal fistula is an important consideration for pathologists and requires careful consideration in the postmortem setting.

Rokitansky diverticulum with esophageo-spinal fistula leading to infective spondylodisciitis – A case report and review of literature

Background- Infective thoracic spondylodiscitis secondary to spontaneous perforation of the esophageal diverticulum is a rare condition. Case Report- A 56-year-old lady with cystic lung disease and pulmonary arterial hypertension of nine years duration and progressive dysphagia for two years was diagnosed with mid-esophageal diverticulum five months prior to presentation. The lady presented with infrascapular chest wall pain of one month’s duration and dyspnoea and wheezing of 15 days duration. Imaging showed a mid-esophageal diverticulum at T4-T5 level with a sinus tract extending to the T2-T3 disc, reduced T2-T3 disc height with endplate irregularities, and contrast enhancement of T2-T5 vertebral bodies suggestive of spondylodiscitis. Although a percutaneous vertebral biopsy was inconclusive, the blood culture grew Streptococcus Pseudoporcinus. The esophageal diverticulum was managed with an endoluminal stent and the infective spondylodisciitis was managed with an extended course of antibiotics led to the healing of both lesions. Conclusions- A Rokitansky mid-esophageal diverticulum with esophageo-spinal fistula causing infective spondylodisciitis is a rare condition. A combined management of the leaking esophageal diverticulum using an esophageal endoluminal metallic stent and an extended course of antibiotics to treat the infective spondylodisciitis led to a good outcome.

Magnets and self-retractable wire for endoscopic septotomies: From concept to first-in-human use.

Background and study aims: A medical device that allows simple and safe performance of an endoscopic septotomy could have several applications in the gastrointestinal (GI) tract. We developed such a device by combining two magnets and a self-retractable wire to perform a progressive septotomy by compression of the tissues. We describe here the concept, preclinical studies, and first clinical use of the device in symptomatic epiphrenic esophageal diverticulum (EED). Materials and methods: The MAGUS was designed based on previous knowledge of compression anastomosis and current unmet needs. After initial design, the feasibility of the technique was tested on artificial septa in pigs. A clinical trial was then initiated to assess the feasibility and safety of the technique. Results: Animal studies showed that the MAGUS can perform a complete septotomy at various levels of the GI tract. In two patients with symptomatic EED, uneventful complete septotomy was observed within 28 and 39 days after the endoscopic procedure. Conclusions: This new system provides a way to perform endoluminal septotomy in a single procedure. It appears to be effective and safe for managing symptomatic EED. Further clinical applications where this type of remodeling of the GI tract could be beneficial are under investigation.

Rokitansky diverticulum with esophageo-spinal fistula leading to infective spondylodisciitis – A case report and review of literature

Background- Infective thoracic spondylodiscitis secondary to spontaneous perforation of the esophageal diverticulum is a rare condition. Case Report- A 56-year-old lady with cystic lung disease and pulmonary arterial hypertension of nine years duration and progressive dysphagia for two years was diagnosed with mid-esophageal diverticulum five months prior to presentation. The lady presented with infrascapular chest wall pain of one month’s duration and dyspnoea and wheezing of 15 days duration. Imaging showed a mid-esophageal diverticulum at T4-T5 level with a sinus tract extending to the T2-T3 disc, reduced T2-T3 disc height with endplate irregularities, and contrast enhancement of T2-T5 vertebral bodies suggestive of spondylodiscitis. Although a percutaneous vertebral biopsy was inconclusive, the blood culture grew Streptococcus Pseudoporcinus. The esophageal diverticulum was managed with an endoluminal stent and the infective spondylodisciitis was managed with an extended course of antibiotics led to the healing of both lesions. Conclusions- A Rokitansky mid-esophageal diverticulum with esophageo-spinal fistula causing infective spondylodisciitis is a rare condition. A combined management of the leaking esophageal diverticulum using an esophageal endoluminal metallic stent and an extended course of antibiotics to treat the infective spondylodisciitis led to a good outcome.