Epiphrenic Diverticula. Primum Non Nocere (First Do Not Harm)

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Epiphrenic Diverticula. Primum Non Nocere (First Do Not Harm)

Giovanni Zaninotto, Sheraz Markar
Editorials, no. 1, 2018
Article DOI: 10.21614/chirurgia.113.1.15
Epiphrenic diverticula (ED) are out-pouchings of the esophageal lumen most commonly originating in the distal third of the esophagus, close to the diaphragm. They have historically been considered ‘pulsion’diverticula due to high intra-luminal pressures in a short segment of the esophagus in contrast with mid thoracic diverticula that are deemed to be caused by a chronic inflammatory processes starting from the mediastinal lymph nodes (due to granulomatous diseases, such as tuberculosis) (1,2). The prevalence of ED is unknown:radiological studies (contrast esophagogram) have shown a prevalence of ED of around 0.015% in the US, 0.77% in Japan and 2% in Europe (3,4). Trastek estimated the ratio of epiphrenic to Zenker’s diverticula at 1:5 and, since the incidence of Zenker’s diverticula is generally assumed to be less than 1/100,000/year, the estimated incidence of epiphrenic diverticula would be approximately 1/500,000/year; such a figure gives us an idea of just how rare diverticula of the thoracic esophagus are (5). Symptoms of ED are variable in type, severity and frequency: dysphagia, regurgitation, chest pain and /or aspiration problems are reported; most likely these symptoms are associate with the underlying motor disturbance rather than the ED itself (6), especially in case of small ED. The proportion of diverticula reportedly symptomatic enough to warrant surgery is highly variable, ranging from 0% to 50% (7,8).