A case report of achalasia and large epiphrenic diverticulum treated by peroral endoscopic myotomy combined with diverticuloseptotomy

The combination of esophageal achalasia with epiphrenic diverticulum is extremely rare and mostly treated surgically. Several cases of successful endoscopic treatment were presented in the literature, but treatment strategy has not yet been defined. Aim. To present a case of the rare combination as achalasia and giant esophageal epiphrenic diverticulum successfully treated endoscopically. Case report. We present to your attention a case report of a 75-year-old woman with complete dysphagia, significant weight loss, who was diagnosed with symptomatic epiphrenic diverticulum secondary to achalasia. Upper gastrointestinal endoscopy showed signs of severe fibrosis in the submucosal layer of the diverticulum. She received peroral endoscopic myotomy combined with diverticuloseptotomy made from the same submucosal tunnel. The regression of symptoms from 10 to 2 points according to the Eckardt symptom score clinically showed the treatment success. Conclusions. The presented endoscopic one-tunnel technique could be an effective miniinvasive option for large symptomatic epiphrenic diverticula associated with achalasia.