Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2019; 25(12): 1457-1464
Published online Mar 28, 2019. doi: 10.3748/wjg.v25.i12.1457
Esophageal diverticulum: New perspectives in the era of minimally invasive endoscopic treatment
Hiroki Sato, Manabu Takeuchi, Satoru Hashimoto, Ken-ichi Mizuno, Koichi Furukawa, Akito Sato, Junji Yokoyama, Shuji Terai
Hiroki Sato, Satoru Hashimoto, Ken-ichi Mizuno, Junji Yokoyama, Shuji Terai, Division of Gastroenterology, Niigata University Medical and Dental Hospital, Niigata 951-8510, Japan
Manabu Takeuchi, Division of Gastroenterology, Nagaoka Red Cross Hospital, Nagaoka 940-2085, Japan
Koichi Furukawa, Division of Gastroenterology, Niigata City General Hospital, Niigata 950-1197, Japan
Akito Sato, Division of Gastroenterology, Nagaoka Chuo General Hospital, Nagaoka 940-8653, Japan
Author contributions: Sato H designed the research study and wrote the paper; Takeuchi M, Hashimoto S, Mizuno K, Furukawa K, Sato A and Yokoyama J performed the research; Terai S critically contributed to revision of the manuscript.
Conflict-of-interest statement: No potential conflicts of interest.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Hiroki Sato, MD, PhD, Assistant Professor, Division of Gastroenterology and Hepatology, Niigata University Medical and Dental Hospital, 757-1, Asahimachidori, Chuo-ku, Niigata 951-8510, Japan.
Telephone: +81-25-2272207 Fax: +81-25-2270776
Received: January 23, 2019
Peer-review started: January 23, 2019
First decision: February 21, 2019
Revised: February 28, 2019
Accepted: March 11, 2019
Article in press: March 12, 2019
Published online: March 28, 2019

Esophageal diverticula are rare conditions that cause esophageal symptoms, such as dysphagia, regurgitation, and chest pain. They are classified according to their location and characteristic pathophysiology into three types: epiphrenic diverticulum, Zenker’s diverticulum, and Rokitansky diverticulum. The former two disorders take the form of protrusions, and symptomatic cases require interventional treatment. However, the esophageal anatomy presents distinct challenges to surgical resection of the diverticulum, particularly when it is located closer to the oral orifice. Since the condition itself is not malignant, minimally invasive endoscopic approaches have been developed with a focus on alleviation of symptoms. Several types of endoscopic devices and techniques are currently employed, including peroral endoscopic myotomy (POEM). However, the use of minimally invasive endoscopic approaches, like POEM, has allowed the development of new disorder called iatrogenic esophageal diverticula. In this paper, we review the pathophysiology of each type of diverticulum and the current state-of-the-art treatment based on our experience.

Keywords: Diverticulum, Esophagus, Epiphrenic diverticulum, Zenker’s diverticulum, Rokitansky diverticulum, Iatrogenic disease, Esophageal achalasia, Peroral endoscopic myotomy, Diverticulectomy

Core tip: Esophageal diverticula are rare but can cause difficulty in swallowing. They are classified into three major categories according to their pathophysiology and location: epiphrenic diverticulum, Zenker’s diverticulum, and Rokitansky diverticulum, with the former two presenting as clinically significant protrusions and symptomatic cases requiring interventional treatment. However, the esophageal anatomy presents challenges to surgical resection, and the condition itself is not malignant. Therefore, minimally invasive endoscopic treatments have been developed. In this paper, we review the pathophysiology and up-to-date treatment of each diverticulum.