Published online Mar 28, 2019. doi: 10.3748/wjg.v25.i12.1457
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.
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.