Introduction:
Esophageal diverticulectomy is a surgical method by which an esophageal diverticulum is corrected. An esophageal diverticulum is an outer pouch or pocket-like sac formed inside the esophagus. It can be caused either by pulsion or traction. An esophageal diverticulum is managed by cutting it out completely by a process called diverticulectomy or by suspending and stitching it to the esophageal wall called diverticulopexy.
What Is Esophageal Diverticulum?
An esophageal diverticulum is an outer pouch or pocket-like sac formed inside the esophagus. An esophagus is a muscular tube used for swallowing, it connects the mouth to the stomach. The esophagus is surrounded by a mucous lining, like the rest of the gastrointestinal (GI) tract. An esophageal diverticulum is seen in weak spots in the lining of the esophagus. It is extended outward and forms tiny caverns.
What Causes Esophageal Diverticulum?
An esophageal diverticulum can be caused by two types of causes: pulsion and traction. Many esophageal diverticula are the pulsion type. The meaning of pulsion is pushing, something is repeatedly pushed against the esophagus wall in one place. This happens while swallowing the food. Esophageal issues that result in problems while swallowing can be the reason for abnormal pressure inside the esophagus. Some of such reasons are:
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Esophageal spasms.
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Eosinophilic esophagitis.
What Are the Symptoms of Esophageal Diverticulum?
Esophageal diverticula frequently does not produce any symptoms. One might not even realize that they have one. Zenker diverticula displays symptoms. Some of the symptoms seen are:
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Tickling in the throat that makes a person cough.
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A lump in the throat while swallowing.
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The feeling of food stuck in the throat.
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Regurgitation of food when you bend over or lie down.
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Unexplained bad breath.
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Unexplained wheezing.
How Is an Esophageal Diverticulum Diagnosed?
Esophageal Diverticulum can be diagnosed by the test, which can look inside the esophagus. As most of the esophageal diverticula do not show symptoms, they are mostly revealed suddenly while looking for something else. If symptoms are absent in the esophagus, a doctor examines it by radiology or endoscopy. In radiology, pictures are taken from the outside, while in endoscopy from the inside. The tests which diagnose an esophageal diverticulum are:
- Esophagram: An esophagram is a kind of X-ray that produces images of the esophagus in a video form while swallowing (fluoroscopy). It is also known as a barium swallow test. For the test, one needs to swallow a chalky contrast solution called barium that coats the inside of the esophagus. A live X-ray video is shot by a technician while swallowing.
- Upper Endoscopy: An upper endoscopy is performed to check inside the upper gastrointestinal tract with an endoscope. A small camera on the end of a long tube is attached. It is performed by an endoscopist, who passes the endoscope via the mouth and down through the esophagus into the stomach while the patient is sedated. The camera shows the images on a computer screen.
- Esophageal Manometry Test: The doctor and team might advise this test to detect swallowing problems, which frequently cause esophageal diverticula. The test gives the strength of the swallowing muscles while swallowing. It evaluates them through sensors embedded in a nasogastric tube passed through the esophagus.
How Is an Esophageal Diverticulum Managed?
Most esophageal diverticulums do not require treatment if they do not show any symptoms or complications. These can be left alone. But if a diverticulum shows symptoms or problems, it must be removed by any particular procedure to close or remove it. Doctors do it in a few different ways. Treatment for the original disorder that caused the esophageal diverticulum might also be required. A doctor can correct an esophageal diverticulum by surgery or by endoscopy. Different approaches might be better for different kinds of diverticula. The physician will also see an individual's overall health while considering their treatment. For example, endoscopy might be a good option if a minimally invasive approach is required. In the case of an esophageal diverticulum, it is mostly managed by a surgical method known as esophageal diverticulectomy.
What Is Diverticulectomy?
A diverticulectomy is a process done when esophageal diverticula is considered to be the cause of aspiration. An abdominal laparoscopic approach might be suitable for some patients with epiphrenic diverticula. Case reports of endoscopic treatment of giant mid-esophageal diverticula have been reported. However, the patients being considered for diverticulectomy should first take a careful study with a barium swallow, flexible endoscopy, and esophageal manometry. Treatment directed at an underlying esophageal motility disorder, such as achalasia, cannot be ignored.
Diverticulectomy is generally not done by itself as it does not correct the deformity in cricopharyngeal function that frequently leads to forming a Zenker's diverticulum. The transcervical approach is been used by the transoral route traditionally using a rigid esophagoscope also might be considered. It is seen that better results have been received by doing a diverticulotomy with the help of a flexible endoscope and needle-knife papillotomy to cut the wall between the diverticulum, the oropharynx, and the cricopharyngeus. At the same time, the patient is given sedation consciously. Studies also reveal that this technique provides good results with a relatively high success rate, but it should be performed in large places with experienced surgeons. In some forms of this technique, the diverticulum is also stapled.
What Is an Esophageal Diverticulectomy?
An esophageal diverticulum is corrected by removing it fully, known as esophageal diverticulectomy, or by stitching it to the esophageal wall or diverticulopexy. A myotomy might also do the surgical correction. Myotomy is the process of cutting one of the esophageal muscles to release excess tension. This might be important to correct the swallowing problem present in the esophageal diverticulum.
After the procedure, one might stay in the hospital for a day and rest for a few weeks at home. The throat might be sore and swollen for a few weeks, swallowing difficult. Doctors give instructions on pain relief, though it might not be required. The doctor will also suggest how and when to progress from a liquid to a soft diet and resume the normal diet.
Conclusion:
An esophageal diverticulum is an outer pouch or pocket-like sac formed inside the esophagus. An esophagus is a muscular tube used for swallowing, it connects the mouth to the stomach. This created problems with swallowing, speech, etc. Therefore, it is advised to either get it removed or stitched. It is repaired by a surgical procedure known as esophageal diverticulectomy.
