Epiphrenic Diverticula

Excerpt

Esophageal diverticulum, a relatively rare condition, is classified based on its location in the esophagus: proximal (Zenker or phrenoesophageal, comprising 70% of cases), midesophageal (thoracic and mediastinal, 10% of cases), or distal (epiphrenic, 20% of patients). Epiphrenic diverticulum, or pulsion diverticulum, is a rare type of esophageal diverticulum occurring in the distal 10 centimeters of the esophagus, most often 4 to 8 cm superior to the gastric cardia. These diverticula comprise the mucosal and submucosal lining, herniating through a weakness in the muscularis layer of the esophagus, classifying them as false or pseudodiverticula. This anatomical weakness in the muscularis layer is where nerves and blood vessels enter to supply the distal esophagus.

The surgical treatment for symptomatic esophageal diverticula varies according to its location. Surgical approaches for lower esophageal (epiphrenic) diverticula have evolved from the initial open transthoracic method to the currently preferred abdominal approach, particularly with the advent of laparoscopy. This preference is likely due to the enhanced visualization of the gastroesophageal junction and distal esophagus during myotomy and the ability to perform fundoplication simultaneously, as many patients are also diagnosed with gastroesophageal reflux disease.