Acta Scientific Gastrointestinal Disorders (ISSN: 2582-1091)

Case Report Volume 3 Issue 7

Spectrum of Pulsion Esophageal Diverticulum and Approach to the Management Based on Presence or Absence of Symptoms

Ajeet Kumar Lohana, Rajesh Bansari, Fakhar Ali Qazi Arisar, Wasim Jafri*

Department of Medicine, Section of Gastroenterology, Aga Khan University Hospital, Karachi, Pakistan

*Corresponding Author: Wasim Jafri MD, FRCP, FACG, FASSLD,, Professor of Medicine, Department of Medicine, Section of Gastroenterology, Director of WGO training Center Karachi Pakistan.

Received: May 25, 2020; Published: June 19, 2020

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Abstract

Introduction: Pulsion esophageal diverticulum (PED) is a rare esophageal disorder. A minority of individuals develops characteristic symptoms, such as dysphagia, however; the majority does not produce any symptoms. Progression and requirement of a follow up in asymptomatic diverticulum is not well determined. In this study, the spectrum of presentation and approach to management of PED based on presence or absence of symptoms is determined.

Method: In this retrospective study, 28 consecutive patients identified having PED from January 2010 to December 2017. Information regarding clinical spectrum of the disease and treatments were recorded. Patients follow up charts were reviewed to determine onset of new symptoms in asymptomatic individuals and resolution/recurrence of symptoms in symptomatic individuals after respective treatments.

Results: Mid esophageal diverticulum (MD) was the most common diverticulum (17/28) (60.7%). 13/28 (46.42%) of individuals were asymptomatic and all of these patients harbor MD of ≤1 cm in size. Over a mean follow up of 14 months none of asymptomatic patient developed new symptoms and/or complications. A total of 15/28 (53.54%) patients were symptomatic, predominantly with dysphagia (10/15) (66.66%) and having Zenker’s Diverticulum (ZD) among 4, MD among 4, Epiphrenic Diverticulum (ED) among 6, and MD+ED among 1 patient. Out of 15 symptomatic patients, one third (5/15) of patients underwent surgical interventions due to persistent troublesome symptoms; another one third (5/15) could not undergo surgical resection despite persistent symptoms because of comorbid condition and patient refusal; and in remaining one third (5/15) of patients the symptoms were fairly controlled with supportive treatment only. 1/5 (20%) of symptomatic individuals who underwent surgery had recurrence of symptoms postoperatively.

Conclusion: MD type with ≤1 cm may not require treatment or long term follow up. Zenker’s and Epiphrenic Diverticula produce persistent symptoms even if small. Two thirds of such symptomatic patients require surgical or endoscopic resection because of troublesome symptoms; however rest of symptomatic patients can be controlled with supportive treatment without necessitating surgical intervention.

Clinical Significance: The study determines the effective approach to PED based on presence or absence of symptoms.

Keywords: Esophagus; Zenker’s Diverticulum; Epiphrenic Diverticulum; Mid-esophageal Diverticulum; Pulsion; False Diverticulum; Treatment; Symptom Based Approach

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Citation

Citation: Wasim Jafri., et al. “Spectrum of Pulsion Esophageal Diverticulum and Approach to the Management Based on Presence or Absence of Symptoms”.Acta Scientific Gastrointestinal Disorders 3.7 (2020): 02-08.



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