OBJECTIVE

This study aimed to assess the efficacy of peroral endoscopic myotomy (POEM) in managing epiphrenic diverticula of the esophagus.

MATERIAL AND METHODS

Our study involved four patients (two females), aged 62 to 67, with a 3—10-year history of the disease. One patient had a recurrence of the disease after laparoscopic diverticulectomy. Patients’ upper GI fluoroscopy and endoscopy revealed diverticulum sized from 4 to 7 cm on a narrow base, containing food and liquid, situated in the lower third of the esophagus. All patients exhibited non-productive contractions in the middle and lower thirds of the esophagus.

RESULTS

Undergoing POEM, patients had diverticula septum dissected. No complications were noted during or after the procedure. POEM duration spanning 110 to 195 minutes (mean of 133.5 minutes) and myotomy length varying from 15 to 30 cm (mean of 16.4 cm). Six and twelve-month follow-ups showed no ingestion issues, positive patient feedback. Post-operative assessments using upper GI fluoroscopy showed normal contrast flow into the stomach. Endoscopy confirmed a reduction in diverticulum size. All patients exhibited a decline in the Eckardt score from 10 to 0 points (average 0.25). One patient was diagnosed with grade B erosive esophagitis, which was effectively managed with proton pump inhibitors.

CONCLUSION

POEM has proven to be highly effective and safe for treating epiphrenic diverticula, significantly enhancing patients’ oral food intake. It stands as a viable alternative to conventional surgical approaches. However, long-term monitoring is recommended to address the potential development of gastroesophageal reflux post-operation.