Case Report | Case Rep J. 2017;1(1):002 | Open Access

Epiphrenic Diverticulum: A Case Report

Zachary Smith, George Salem and Donald Kastens



A 64-year-old-man was referred for EGD for dysphagia. A chest CT showed middle and lower esophageal wall thickening and distension with air and fluid levels. EGD revealed moderately dilated esophagus with stasis esophagitis. A diverticulum with a large opening and no stigmata of recent bleeding was found several centimeters proximal to the lower esophageal sphincter (LES). Moderate resistance was felt during advancement into the stomach. Dilation was performed using through-the-scope balloon dilation to a maximum balloon size of 18 mm without overt effect. Motility study showed intermittent simultaneous contractions and hypertensive LES with incomplete relaxation, suggestive of evolving type 3 achalasia. We prescribed fluconazole and preprandial sublingual nitroglycerin for dysphagia. Two months following endoscopy the patient reports improved dysphagia and weight gain. Epiphrenic diverticula are pulsion diverticula that form as a result of elevated intraluminal esophageal pressure due to primary motility disorders such as achalasia, diffuse esophageal spasm, and nutcracker esophagus. Diverticula can present with symptoms that can mimic more common diseases (e.g., GERD, gastroparesis, or eosinophilic esophagitis) or be asymptomatic in as many as 40% of patients. Undiagnosed, epiphrenic diverticula can lead to or further worsen regurgitation, gastrointestinal bleeding, aspiration, and cancer.

Keywords: Epiphrenic diverticulum; Endoscopy; Achalasia; Motility disorders

Citation: Smith Z, Salem G, Kastens D. Epiphrenic Diverticulum: A Case Report. Case Rep J. 2017;1(1):002