Modern pathophysiology and treatment of esophageal diverticula

Langenbecks Arch Surg. 2012 Jan;397(1):29-35. doi: 10.1007/s00423-011-0843-2. Epub 2011 Sep 2.

Abstract

Introduction: Esophageal diverticula are rare. They may occur in the pharyngoesophageal area (Zenker's), midesophagus, or distally (epiphrenic). A motility disorder (either at the level of the esophageal sphincters or body) is frequently associated with esophageal diverticula. The risk of malignant transformation is low.

Methods: A literature search was performed using Medline/PubMed database.

Results: The treatment of esophageal diverticula must be based on the pathophysiology and natural history of the disease: (a) asymptomatic diverticula do not need a specific treatment, (b) small diverticula may be left in place and not resected, (c) medium-size diverticula may be either treated by diverticulectomy, diverticulopexy, or esophagodiverticulostomy in case of pharyngoesophageal diverticula, (d) resection is probably the ideal therapy for larger diverticula, and (e) a myotomy should always be included to the procedure.

Conclusions: Due to its rarity, esophageal diverticula must be treated by esophageal surgeons since even in experienced hands the complication rate can be significant.

Publication types

  • Review

MeSH terms

  • Digestive System Surgical Procedures / methods
  • Diverticulum, Esophageal / diagnosis
  • Diverticulum, Esophageal / physiopathology
  • Diverticulum, Esophageal / surgery*
  • Endoscopy, Gastrointestinal / methods
  • Humans