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.

A Case of a Giant Epiphrenic Esophageal Diverticulum

The esophageal diverticula are divided into pharyngoesophageal, parabronchial and epiphrenic. They could also be divided into congenital and acquired, true and false, pulsion and traction. Pulsion diverticula are usually formed in motor disorders of the esophagus, above the place of hypertension and uncoordinated peristalsis. They are pseudo-diverticula caused by increased intramural pressure, leading to herniation of the mucosa and submucosa through the focal areas of the esophageal wall. We present a 65-year-old woman who underwent left-sided transthoracic diverticulectomy, modified Heller esophagocardiomyotomy, and modified Belsey-Mark IV fundoplication due to a huge epiphrenic esophageal diverticulum.

A Rare Case of Bleeding Epiphrenic Esophageal Diverticulum From Arteriovenous Malformations

Epiphrenic esophageal diverticula (EED) is a rare condition that usually presents with dysphagia in patients with a known motility disorder. In this article, we present a unique case of EED presenting with hemoptysis with clinical workup negative for any pulmonary pathology. Esophagogastroduodenoscopy revealed arteriovenous malformations within the EED successfully managed with argon plasma coagulation (APC), leading to a resolution of the patient’s symptoms.