Epiphrenic diverticula are pulsion diverticula of the distal oesophagus arising just above the lower esophageal sphincter (LES), more frequently on the right posterolateral wall.
They are less frequent than traction mid oesophageal diverticula, but may have more clinical relevance.
Epiphrenic diverticula may present with symptoms of dysphagia, and regurgitation. When large they can cause distal oesophageal compression.
These are considered to be pulsion type diverticula, thought to arise due to increased intraluminal pressure and hence the strong association with oesophageal dysmotility.
The diverticulum forms as the submucosa and mucosa herniate focally through the muscularis propria. Since the diverticular wall lacks the muscular layer, it is classified as a "false" diverticulum.
They are associated with:
- achalasia and other forms of neuromuscular dysfunction of the oesophagus
- hiatus hernia
- oesophageal stricture
- oesophageal web
Fluoroscopy: barium swallow
Best imaging method is a single contrast oesophagogram, including prone RAO oblique views of the distal oesophagus.
- determine the relationship between the diverticulum and the gastro-oesophageal junction
- look for evidence of oesophageal motility disorders and hiatus hernia.
On chest X-ray, they may appear as a retrocardiac soft tissue mass with or without an air-fluid level, mimicking a hiatus hernia.
Treatment and prognosis
Epiphrenic diverticula can be treated surgically with myomectomy or diverticulectomy.
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