Modern pathophysiology and treatment of esophageal diverticula

Herbella, Fernando A. M.; Patti, Marco G.

doi:10.1007/s00423-011-0843-2

Cited by 106 publications

(135 citation statements)

References 54 publications

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“…[3,17] It appears that the advantages of the minimally invasive approach include: easy access, improved visualization, proper stapling line, possibility of myotomy and antirefl ux technique, along with the possibility of treating any complication during the surgery. In addition, there is a shorter hospital stay and minimal analgesia requirements.…”

Section: Discussionmentioning

confidence: 99%

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Minimally invasive therapy of epiphrenic diverticula: Systematic review of the literature and report of 6 cases

Calatayud¹

2017

Laparosc Endosc Surg Sci

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Epiphrenic diverticula is an uncommon disease, and conventional surgical treatment entails aggressive open or transthoracic surgery. Minimally invasive treatment has changed the surgical approach, but a number of surgical controversies remain unresolved. The present study is a description of our experience with minimally invasive treatment of epiphrenic diverticula and a systematic review of the current literature on this subject. All data from the Hospital de Sant Pau were reviewed to identify patients who underwent minimally invasive treatment for epiphrenic diverticulum since 1998. In addition, systematic literature review focused on minimally invasive approach for epiphrenic diverticula was performed. Total of 6 patients have been treated (6 transhiatal and 1 with abdominal and thoracic approach) at the hospital. Predominance of male patients was observed, with median age of 63 years. Diagnosis was made with endoscopy, barium swallow, or manometry. Half of manometry results where pathological. Surgical techniques applied were diverticulectomy, myotomy, and Dor partial fundoplication. Two patients with suture line leakage were treated conservatively. No mortality was reported. Systematic literature review was conducted using the PRISMA scheme, and 21 studies with 189 patients were found. No comparative or prospective randomized trials were located. Overall morbidity rate was 24%, suture line leakage rate was 12%, hospital stay was 5 days, and mortality rate of 1.5% in the literature. After median follow up of 42 months, 81.5% of the patients were asymptomatic. Minimally invasive approach for epiphrenic diverticula is a safe and feasible procedure.

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Section: Discussionmentioning

confidence: 99%

“…[1,2] There is an estimated prevalence of 0.015% in the United States, 0.77% in Japan and up to 2% in Europe. [3][4][5][6][7][8] In 1998, Rosati et al [9] was the first surgeon to perform a minimally invasive transhiatal access for epiphrenic diverticulum (ED) on a patient.…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive therapy of epiphrenic diverticula: Systematic review of the literature and report of 6 cases

Calatayud¹

2017

Laparosc Endosc Surg Sci

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“…(2) Currently, the therapeutic attitude varies between conservative and surgical, classical or endoscopic treatment. Treatment should be reserved for symptomatic patients with or without associated complications (3,4), while small, asymptomatic diverticula do not require treatment, as the risk of severe adverse events (cancer, aspiration pneumonia) is reduced (5). The surgical indication, as expressed in the literature, is still vaguely specified, varies between the formal indication for surgery, determined by the simple presence of the diverticular sac at the pharyngoesophageal level, up to a case-adjusted attitude depending on the presence of the symptomatology specific age, associated illness and of course the installation of direct complications, an attitude we opt for.…”

Section: Introductionmentioning

confidence: 99%

Zenker Diverticulum Treatment: Endoscopic or Surgical?

Ciuc¹,

Bîrlă²,

Panaitescu³

et al. 2018

chr

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RezumatIntroducere: Diverticulul Zenker constituie o patologie rară, selecţia pacienţilor pentru tratamente invazive este discutabilă, precum şi metoda terapeutică aplicată. Scopul studiului este de a evalua principalele metode de tratament-chirurgical clasic si endoscopic, în această patologie şi de a corela aspectele fiziopatologice cu consecinţele clinice. Material şi metodă: Am inclus în lotul de studiu 36 pacienţi cu diverticuli cervicali Zenker trataţi în perioada 2010/2017 în două clinici universitare: 7 pacienţi prin abord chirurgical clasic la Clinica de Chirurgie Generală şi Esofagiană a Spitalului Clinic Sfânta Maria Bucureşti şi 29 de pacienţi cu abord endoscopic la Departamentul de Endoscopie Digestivă de Diagnostic şi Intervenţională din cadrul Institutului Regional de Hepatologie şi Gastroenterologie Prof. Dr. Octavian Fodor, Cluj-Napoca. Vârsta pacienţilor a fost cuprinsă între 42 şi 84 ani şi în decada a 7a -15 pacienţi. Rezultate: Miotomia cricofaringiană s-a efectuat la toţi pacienţii. Diverticulectomia s-a practicat la 7 pacienţi, cei trataţi chirurgical. Durata de spitalizare medie a fost de 4 zile. Complicaţii intraprocedurale au prezentat 3 pacienţi trataţi endoscopic şi au constat în apariţia hemoragiei laminare. La 2 pacienţi s-a practicat hemostază endoscopică cu clipuri şi pensă caldă iar la un pacient s-a efectuat hemostază endoscopică cu clipuri. Complicaţiile postprocedurale au fost: dureri locale, leucocitoză, melenă, febră,

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“…Additionally, there are more internal structures around the mid-esophageal location type of acquired diverticula, and the strategy for surgical repair may be affected [5].…”

mentioning

confidence: 99%

“…Sci. 74(9): 1233-1236, 2012 The use of multi-detector computed tomography (MDCT) and three-dimensional (3D) reconstruction for esophageal diseases, such as bronchoesophageal fistula, diverticula and tumor, have been actively studied in human medicine [1]. Imaging of the gastrointestinal tract, including the esophagus, became possible by using the MDCT technology with high-quality multi-planar reformation and visualization by 3D reconstruction [1,10].…”

mentioning

confidence: 99%

Characteristics of Esophageal Diverticula Using Computed Tomography and Three-Dimensional Reconstruction in a Maltese Dog

Park

Kim

Park

2012

The Journal of Veterinary Medical Science

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ABSTRACT. A 7-year-old intact female Maltese dog was referred with ptyalism and intermittent vomiting but no regurgitation for over 1 month. Survey radiographs including a contrast study revealed a large circular dilated cavity from the carina to the diaphragm. Additionally, multi-detector computed tomography and three-dimensional reconstruction were performed. These images revealed large idiopathic distal esophageal diverticula. This case report represents the first report using multi-detector computed tomography and three-dimensional reconstruction for evaluation of esophageal diverticula in a dog. KEY WORDS: 3D reconstruction, canine, CT, esophageal diverticula.doi: 10.1292/jvms.11-0546; J. Vet. Med. Sci. 74(9): 1233-1236, 2012 The use of multi-detector computed tomography (MDCT) and three-dimensional (3D) reconstruction for esophageal diseases, such as bronchoesophageal fistula, diverticula and tumor, have been actively studied in human medicine [1]. Imaging of the gastrointestinal tract, including the esophagus, became possible by using the MDCT technology with high-quality multi-planar reformation and visualization by 3D reconstruction [1,10]. Also, CT has the ability to cover a large volume in a very short scan time [1]. This case report describes the characteristics of large esophageal diverticula diagnosed by CT and 3D reconstruction.A 7-year-old, intact female Maltese dog weighing 1.3 kg was referred with chronic ptyalism and intermittent vomiting but no regurgitation for over 1 month. This dog had displayed progressive weight loss for the preceding few months. On physical examination, the dog did not have any oral and pharyngeal problems such as foreign body or structural abnormality, which can manifest with similar symptoms.Initial diagnostic tests including complete blood count, serum biochemistry, electrolytes, and blood gas analysis were performed. All results were within reference ranges, except for mild normocytic-normochromic regenerative anemia (packed cell volume [PCV] 34%, reference range, 37%-55%) and increased serum amylase (732 U/l, reference range, 185-700 U/l).Survey radiography of the thorax showed a large circular dilated soft-tissue density line from the carina to the diaphragm on both the right lateral and ventrodorsal views (Fig. 1). Abdominal radiography revealed a gas-filled stomach and intestine. The collective result prompted the suspicion of an esophageal foreign body, diverticula or mass. A contrast radiographic study and fluoroscopy were also performed with iohexol (2 ml/kg, Omnipaque™ 300 mg I/ ml, GE Healthcare (Shanghai) Co., Ltd., Shanghai, China ). Contrast images showed a large cavity with contrast agent cranial to the diaphragm that separated from the stomach immediately after administration (Fig. 2). And, 1 hr after administration, almost all the contrast agents were evident in the stomach and intestine, with little in the thoracic cavity. During fluoroscopy, contrast agents flowed into the cavity first, before entering the stomach with relatively decreased esophagea...

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Modern pathophysiology and treatment of esophageal diverticula

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

Cited by 106 publications

References 54 publications

Minimally invasive therapy of epiphrenic diverticula: Systematic review of the literature and report of 6 cases

Minimally invasive therapy of epiphrenic diverticula: Systematic review of the literature and report of 6 cases

Zenker Diverticulum Treatment: Endoscopic or Surgical?

Characteristics of Esophageal Diverticula Using Computed Tomography and Three-Dimensional Reconstruction in a Maltese Dog

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