Achalasia and Epiphrenic Diverticulum

P. Marco Fisichella, Anahita Jalilvand, Adrian Dobrowolsky

Epiphrenic diverticula are a rare disease almost always associated with an underlying motility disorder of the esophagus, such as achalasia. Treatment of any underlying motility disorder must be included in the management of epiphrenic diverticula to prevent postoperative complications and recurrences. Therefore, the goal of this paper is to describe the pathophysiology, clinical presentation, and proper methods of diagnosis and treatment of patients with epiphrenic diverticula. In addition, we aim to provide an overview of the surgical management and discuss the indications for surgery and choice of surgical approach. In general, surgical intervention is favored for symptomatic patients and the optimal surgical approach depends on the size and location of the diverticulum. Surgery is not without seemingly high rates of morbidity when a myotomy is not performed together with the diverticulectomy, even in those with normal manometry. The risk of carcinoma is exceedingly rare and it is usually discovered at later stages; therefore, no surveillance programs have been established in asymptomatic patients with unresected diverticula.