L. Pogliani, E. Zanfrini, D. Tabacco, E. Meacci, S. Margaritora, D. Nachira, V. Porziella
: Esophageal duplication cysts are rare congenital malformations, although most cases are diagnosed in childhood, in adult patients the disease is often symptomatic and requires invasive treatment. This kind of cyst can be found during endoscopy or Chest-X-Ray, but elective investigations consist in chest computed tomography (CT) scan or magnetic resonance imaging (MRI), if necessary, together with gastroscopy performed with endoscopic ultrasound (EUS). The therapeutic alternatives currently available are the surgical or endoscopic approach. In the past surgery was performed in thoracotomy, but several authors have reported cases treated with a minimally invasive approach with excellent short-term and long-term results. We present a case report of a 59-year-old Caucasian woman, affected by esophageal duplication cyst, and treated in 2003 with surgical fenestration in right triportal video-assisted thoracoscopic surgery (VATS) with complete regression of symptoms and resumption of normal nutrition. The cyst recurred in 2019 and the patient underwent further surgery with removal of the cyst in the right uniportal VATS. Postoperative course was regular, the symptoms disappeared, and no complications occurred. During follow-up, chest CT scan showed a complete pathological resolution without cystic recurrence. Currently, many authors agree that the minimally invasive surgical approach is the treatment of choice for esophageal duplication cysts. Our case report shows that VATS is efficient and safe even in treatment of surgical recurrences.
{"title":"Esophageal duplication cyst recurrence: case report and literature review","authors":"L. Pogliani, E. Zanfrini, D. Tabacco, E. Meacci, S. Margaritora, D. Nachira, V. Porziella","doi":"10.21037/aoe-2020-26","DOIUrl":"https://doi.org/10.21037/aoe-2020-26","url":null,"abstract":": Esophageal duplication cysts are rare congenital malformations, although most cases are diagnosed in childhood, in adult patients the disease is often symptomatic and requires invasive treatment. This kind of cyst can be found during endoscopy or Chest-X-Ray, but elective investigations consist in chest computed tomography (CT) scan or magnetic resonance imaging (MRI), if necessary, together with gastroscopy performed with endoscopic ultrasound (EUS). The therapeutic alternatives currently available are the surgical or endoscopic approach. In the past surgery was performed in thoracotomy, but several authors have reported cases treated with a minimally invasive approach with excellent short-term and long-term results. We present a case report of a 59-year-old Caucasian woman, affected by esophageal duplication cyst, and treated in 2003 with surgical fenestration in right triportal video-assisted thoracoscopic surgery (VATS) with complete regression of symptoms and resumption of normal nutrition. The cyst recurred in 2019 and the patient underwent further surgery with removal of the cyst in the right uniportal VATS. Postoperative course was regular, the symptoms disappeared, and no complications occurred. During follow-up, chest CT scan showed a complete pathological resolution without cystic recurrence. Currently, many authors agree that the minimally invasive surgical approach is the treatment of choice for esophageal duplication cysts. Our case report shows that VATS is efficient and safe even in treatment of surgical recurrences.","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45926500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Esophageal stents have been in surgical practice for over a century and continue to advance. Their use has led to changes in treatment paradigms and improved outcomes for a myriad of esophageal diseases. A variety of stents are used in the palliation of dysphagia in patients with malignant disease as well as part of a treatment plan in those with benign conditions. All stent placements begin with upper endoscopy in order to determine exact location of the pertinent pathology and use of a guidewire to set up for stent placement by the chosen technique. The type of stent chosen can vary based upon the etiology and presentation of each patient. In addition to stents that are commonly used today in management of patients, some of the newest developments in stent technology include 3D custom printed stents, biodegradable stents for benign strictures, or incorporating other therapeutic adjuncts to permit the slow-release of anti-cancer drugs. While complications during esophageal stent placement are rare, patients can experience bleeding or pain. These are generally self-limited. The most common complication is stent migration, which can be reduced with endoscopic fixation techniques. Much less common, but significantly more complex, is erosion through the esophagus. As surgical care continues to move towards less invasive approaches, endoscopic stent placement will continue to be a great option for numerous esophageal diseases. New opportunities for technological advancements are emerging that may further change current treatment algorithms for both malignant and benign pathologies. This may further give way to improved long-term outcomes or expansion of treatment options for patients.
{"title":"Clinical applications of esophageal stents","authors":"Mallory K. Wilson, Shamus R. Carr","doi":"10.21037/aoe-21-29","DOIUrl":"https://doi.org/10.21037/aoe-21-29","url":null,"abstract":"Esophageal stents have been in surgical practice for over a century and continue to advance. Their use has led to changes in treatment paradigms and improved outcomes for a myriad of esophageal diseases. A variety of stents are used in the palliation of dysphagia in patients with malignant disease as well as part of a treatment plan in those with benign conditions. All stent placements begin with upper endoscopy in order to determine exact location of the pertinent pathology and use of a guidewire to set up for stent placement by the chosen technique. The type of stent chosen can vary based upon the etiology and presentation of each patient. In addition to stents that are commonly used today in management of patients, some of the newest developments in stent technology include 3D custom printed stents, biodegradable stents for benign strictures, or incorporating other therapeutic adjuncts to permit the slow-release of anti-cancer drugs. While complications during esophageal stent placement are rare, patients can experience bleeding or pain. These are generally self-limited. The most common complication is stent migration, which can be reduced with endoscopic fixation techniques. Much less common, but significantly more complex, is erosion through the esophagus. As surgical care continues to move towards less invasive approaches, endoscopic stent placement will continue to be a great option for numerous esophageal diseases. New opportunities for technological advancements are emerging that may further change current treatment algorithms for both malignant and benign pathologies. This may further give way to improved long-term outcomes or expansion of treatment options for patients.","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46029132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.21037/AOE-2020-MTEC-09
S. Ng, T. Leong
Oesophageal cancer is the ninth most common cancer diagnosed, and seventh most common cause of cancer-related deaths worldwide. Despite significant advances in imaging, surgery, radiotherapy and systemic therapy over the past few decades, treatment outcomes in patients with localised oesophageal cancer remain suboptimal with a 5-year overall survival of less than 50%. Current treatment guidelines recommend surgery with/without pre-operative chemotherapy or chemoradiotherapy for patients with localised resectable disease. Hence, definitive radiotherapy (with or without chemotherapy) has predominantly been reserved for those who are deemed unsuitable for surgery. The role of radiotherapy in definitive management of oesophageal cancer has been recognised since the 1960s. The addition of concurrent chemotherapy has shown to improve treatment outcomes and has remained standard of care since the RTOG 85-01 and Intergroup 0123 trials. This review discusses the current literature on definitive radiotherapy with/without chemotherapy for localised oesophageal cancer, and evaluates current radiation modalities and technological developments in radiotherapy planning and delivery. We will provide an overview on the literature for definitive chemoradiotherapy in oesophageal cancer, the epidemiological and treatment response differences between squamous cell carcinoma and adenocarcinoma of the oesophagus, followed by a review of the current literature on different radiation treatment modalities (intensity modulated radiotherapy, brachytherapy and proton therapy) and the use of different imaging modalities for radiation treatment
{"title":"Indications for definitive chemoradiotherapy for oesophageal cancer","authors":"S. Ng, T. Leong","doi":"10.21037/AOE-2020-MTEC-09","DOIUrl":"https://doi.org/10.21037/AOE-2020-MTEC-09","url":null,"abstract":"Oesophageal cancer is the ninth most common cancer diagnosed, and seventh most common cause of cancer-related deaths worldwide. Despite significant advances in imaging, surgery, radiotherapy and systemic therapy over the past few decades, treatment outcomes in patients with localised oesophageal cancer remain suboptimal with a 5-year overall survival of less than 50%. Current treatment guidelines recommend surgery with/without pre-operative chemotherapy or chemoradiotherapy for patients with localised resectable disease. Hence, definitive radiotherapy (with or without chemotherapy) has predominantly been reserved for those who are deemed unsuitable for surgery. The role of radiotherapy in definitive management of oesophageal cancer has been recognised since the 1960s. The addition of concurrent chemotherapy has shown to improve treatment outcomes and has remained standard of care since the RTOG 85-01 and Intergroup 0123 trials. This review discusses the current literature on definitive radiotherapy with/without chemotherapy for localised oesophageal cancer, and evaluates current radiation modalities and technological developments in radiotherapy planning and delivery. We will provide an overview on the literature for definitive chemoradiotherapy in oesophageal cancer, the epidemiological and treatment response differences between squamous cell carcinoma and adenocarcinoma of the oesophagus, followed by a review of the current literature on different radiation treatment modalities (intensity modulated radiotherapy, brachytherapy and proton therapy) and the use of different imaging modalities for radiation treatment","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47456065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.21037/AOE-2020-ETBE-05
S. Srinivasan, M. Desai
Barrett’s esophagus (BE), a precursor to esophageal adenocarcinoma (EAC) has demonstrated a steep rise in incidence in the last few decades. Patients with high grade dysplasia and/or intramucosal carcinoma are indeed at a higher risk of progression to invasive cancer. Early recognition and endoscopic management could be curative. There have been significant strides in the endoscopic eradication therapy (EET) using resection and ablation techniques in the last 2 decades for management of BE with dysplasia. Once complete eradication is achieved after EET, it is important to follow-up these patients for complications and recurrence. While the importance of this long term-care is appreciated, there is a paucity of studies outlining long-term outcomes and post-therapy follow-up care data. Currently, the same aggressive principles used for original BE with neoplasia are being followed for subjects in remission. Precise definitions of follow up care and quality standards in maintaining durable efficacy are required. Novel techniques and biomarkers have been proposed to assist in the diagnosis and risk stratification but their role in this setting is still unclear. In this review, we present the literature and data on follow up and long-term care of BE patients after successful endoscopic therapy for BE associated dysplasia.
{"title":"Long term care after successful endoscopic therapy in Barrett’s esophagus patients: a review of literature","authors":"S. Srinivasan, M. Desai","doi":"10.21037/AOE-2020-ETBE-05","DOIUrl":"https://doi.org/10.21037/AOE-2020-ETBE-05","url":null,"abstract":"Barrett’s esophagus (BE), a precursor to esophageal adenocarcinoma (EAC) has demonstrated a steep rise in incidence in the last few decades. Patients with high grade dysplasia and/or intramucosal carcinoma are indeed at a higher risk of progression to invasive cancer. Early recognition and endoscopic management could be curative. There have been significant strides in the endoscopic eradication therapy (EET) using resection and ablation techniques in the last 2 decades for management of BE with dysplasia. Once complete eradication is achieved after EET, it is important to follow-up these patients for complications and recurrence. While the importance of this long term-care is appreciated, there is a paucity of studies outlining long-term outcomes and post-therapy follow-up care data. Currently, the same aggressive principles used for original BE with neoplasia are being followed for subjects in remission. Precise definitions of follow up care and quality standards in maintaining durable efficacy are required. Novel techniques and biomarkers have been proposed to assist in the diagnosis and risk stratification but their role in this setting is still unclear. In this review, we present the literature and data on follow up and long-term care of BE patients after successful endoscopic therapy for BE associated dysplasia.","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49043460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Department of Gastroenterology and Hepatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands Contributions: (I) Conception and design: All authors; (II) Administrative support: J Sijben; (III) Provision of study materials or patients: All authors; (IV) Collection and assembly of data: J Sijben, Y Peters; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Jasmijn Sijben. Department of Gastroenterology and Hepatology (route 455), Radboud University Medical Center, Geert Grooteplein-Zuid 8, 6500 HB, Nijmegen, The Netherlands. Email: jasmijn.sijben@radboudumc.nl.
{"title":"Prophylactic eradication of non-dysplastic Barrett’s esophagus to prevent progression to esophageal adenocarcinoma—systematic review and meta-analysis","authors":"Jasmijn Sijben, Y. Peters, P. Siersema","doi":"10.21037/aoe-21-43","DOIUrl":"https://doi.org/10.21037/aoe-21-43","url":null,"abstract":"Department of Gastroenterology and Hepatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands Contributions: (I) Conception and design: All authors; (II) Administrative support: J Sijben; (III) Provision of study materials or patients: All authors; (IV) Collection and assembly of data: J Sijben, Y Peters; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Jasmijn Sijben. Department of Gastroenterology and Hepatology (route 455), Radboud University Medical Center, Geert Grooteplein-Zuid 8, 6500 HB, Nijmegen, The Netherlands. Email: jasmijn.sijben@radboudumc.nl.","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43121525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Apoorva T Ramaswamy, Per Martell, R. Azevedo, P. Belafsky
The upper esophageal sphincter (UES), also known as the pharyngoesophageal segment (PES), is a 4-cm segment of the digestive tract that separates the esophagus from the pharynx and larynx. This narrative review represents an overview of the anatomy and physiology of this critical component of the airway protective mechanism. The structure is bounded anteriorly by the larynx, posterolaterally by the pharyngoesophageal muscles, superiorly by the pharynx and inferiorly by the esophagus. Guarding the entrance of the esophagus, the UES controls inflow and outflow through the region, preventing aerophagia in the anterograde direction as well as regurgitation in the retrograde. Although the cricopharyngeus muscle (CPM) is often considered synonymous with the UES, in reality it is but one component of the complicated anatomy. In fact, relaxation of the CPM is not the primary contributor to UES opening. During the act of swallow, the relaxation of the CPM, elevation of the larynx and propulsion of the food bolus by the pharynx coordinate to open the UES and facilitate deglutition. An understanding of the anatomy of the region in addition to the phases of UES opening facilitates more refined therapeutic interventions for patients with pharyngoesophageal swallow impairment and dysphagia.
{"title":"The upper esophageal sphincter: anatomy and physiology","authors":"Apoorva T Ramaswamy, Per Martell, R. Azevedo, P. Belafsky","doi":"10.21037/aoe-21-34","DOIUrl":"https://doi.org/10.21037/aoe-21-34","url":null,"abstract":"The upper esophageal sphincter (UES), also known as the pharyngoesophageal segment (PES), is a 4-cm segment of the digestive tract that separates the esophagus from the pharynx and larynx. This narrative review represents an overview of the anatomy and physiology of this critical component of the airway protective mechanism. The structure is bounded anteriorly by the larynx, posterolaterally by the pharyngoesophageal muscles, superiorly by the pharynx and inferiorly by the esophagus. Guarding the entrance of the esophagus, the UES controls inflow and outflow through the region, preventing aerophagia in the anterograde direction as well as regurgitation in the retrograde. Although the cricopharyngeus muscle (CPM) is often considered synonymous with the UES, in reality it is but one component of the complicated anatomy. In fact, relaxation of the CPM is not the primary contributor to UES opening. During the act of swallow, the relaxation of the CPM, elevation of the larynx and propulsion of the food bolus by the pharynx coordinate to open the UES and facilitate deglutition. An understanding of the anatomy of the region in addition to the phases of UES opening facilitates more refined therapeutic interventions for patients with pharyngoesophageal swallow impairment and dysphagia.","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46214222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Esophageal cancer is an aggressive and often lethal disease with an increasing incidence worldwide. Originally, the only potentially curative treatment was esophagectomy. However, outcomes of locoregional advanced disease have improved substantially over the last decades by the incorporation of (neo)adjuvant treatment modalities (chemoand/or radiotherapy). Advances in radiotherapy techniques and modalities (e.g., proton therapy) facilitate ‘personalisation’ of high dose radiation delivery for patients who are not surgical candidates. As chemoradiation is very effective in a subset of patients leading to pathologically complete responses, the option of active surveillance instead of standard surgery is currently being investigated. Better patient selection, perioperative care as well as novel surgical techniques have improved the safety and efficacy of surgery. Minimally invasive esophagectomy is increasingly being used and although clear benefits have been described, there is a significant learning curve associated with this complex procedure. How can new surgical innovations be implemented safely now and in the future and what to do with patients who have been treated with definitive chemoradiation therapy? At some point in time, more than 50% of patients present with metastatic disease. Although survival remains dismal in the majority of these patients, there have been important developments in the treatment of dysphagia and a well selected subgroup of patients might be offered more aggressive multimodal therapy. Taken together, the treatment of esophageal cancer is rapidly evolving with novel multimodal developments. This special issue highlights the recent progress that has been made and hopefully this will translate into a more bright future for our patients.
{"title":"Current and future strategies in the treatment of esophageal cancer","authors":"S. Lagarde, B. Wijnhoven, F. Lordick","doi":"10.21037/aoe-2020-51","DOIUrl":"https://doi.org/10.21037/aoe-2020-51","url":null,"abstract":"Esophageal cancer is an aggressive and often lethal disease with an increasing incidence worldwide. Originally, the only potentially curative treatment was esophagectomy. However, outcomes of locoregional advanced disease have improved substantially over the last decades by the incorporation of (neo)adjuvant treatment modalities (chemoand/or radiotherapy). Advances in radiotherapy techniques and modalities (e.g., proton therapy) facilitate ‘personalisation’ of high dose radiation delivery for patients who are not surgical candidates. As chemoradiation is very effective in a subset of patients leading to pathologically complete responses, the option of active surveillance instead of standard surgery is currently being investigated. Better patient selection, perioperative care as well as novel surgical techniques have improved the safety and efficacy of surgery. Minimally invasive esophagectomy is increasingly being used and although clear benefits have been described, there is a significant learning curve associated with this complex procedure. How can new surgical innovations be implemented safely now and in the future and what to do with patients who have been treated with definitive chemoradiation therapy? At some point in time, more than 50% of patients present with metastatic disease. Although survival remains dismal in the majority of these patients, there have been important developments in the treatment of dysphagia and a well selected subgroup of patients might be offered more aggressive multimodal therapy. Taken together, the treatment of esophageal cancer is rapidly evolving with novel multimodal developments. This special issue highlights the recent progress that has been made and hopefully this will translate into a more bright future for our patients.","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45694914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.21037/AOE-2020-MEP-04
M. Marchese, A. Capannolo, A. Giuliani, S. Valiyeva, F. Carlei, L. Lombardi
Esophageal diverticula should be considered as epiphenomena of an esophageal motility disorder, thus a targeted approach should be taken into consideration when a treatment is indicated. Conventional surgical management consists in diverticulectomy or diverticulopexys, associated or not with a myotomy and/or fundoplication on the basis of the underlying motor disorder. A thorough endoscopic evaluation of the diverticulum, associated with a functional assessment of the esophageal motility is mandatory before the treatment. Surgical management of epiphrenic diverticula is often more challenging due to the long operation time and high postoperative complication and mortality rates, and reserved to referral centres. To date, despite the fact that diagnostic workup is now codified, there is not a solid consensus about the management of the diverticula, including the use of routine versus selective myotomy and whether or not a fundoplication should be included. Beyond its classical indications, recently the POEM technique has been applied for the performance of an endoscopic diverticulectomy by mean the submucosal myotomy of the diverticular septum. No literature data about the comparison between these different approaches are reported, so we reviewed literature data about the treatment modalities of diverticula of the esophageal body (mid-esophageal and epiphrenic), to highlight how to best address the choice.
{"title":"“Functional approach” to esophageal body diverticula","authors":"M. Marchese, A. Capannolo, A. Giuliani, S. Valiyeva, F. Carlei, L. Lombardi","doi":"10.21037/AOE-2020-MEP-04","DOIUrl":"https://doi.org/10.21037/AOE-2020-MEP-04","url":null,"abstract":"Esophageal diverticula should be considered as epiphenomena of an esophageal motility disorder, thus a targeted approach should be taken into consideration when a treatment is indicated. Conventional surgical management consists in diverticulectomy or diverticulopexys, associated or not with a myotomy and/or fundoplication on the basis of the underlying motor disorder. A thorough endoscopic evaluation of the diverticulum, associated with a functional assessment of the esophageal motility is mandatory before the treatment. Surgical management of epiphrenic diverticula is often more challenging due to the long operation time and high postoperative complication and mortality rates, and reserved to referral centres. To date, despite the fact that diagnostic workup is now codified, there is not a solid consensus about the management of the diverticula, including the use of routine versus selective myotomy and whether or not a fundoplication should be included. Beyond its classical indications, recently the POEM technique has been applied for the performance of an endoscopic diverticulectomy by mean the submucosal myotomy of the diverticular septum. No literature data about the comparison between these different approaches are reported, so we reviewed literature data about the treatment modalities of diverticula of the esophageal body (mid-esophageal and epiphrenic), to highlight how to best address the choice.","PeriodicalId":72217,"journal":{"name":"Annals of esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48097096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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