Epiphrenic diverticula are pulsion diverticula of the distal oesophagus arising just above the lower esophageal sphincter (LES), more frequently on the right side.
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 thus lacks the muscular layer, it is classified as a false diverticulum.
They are associated with:
Fluoroscopy: barium swallow
Best imaging method is a contrast oesophagogram, including prone oblique views of the distal oesophagus. One should 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, mimicing a hiatus hernia.
Treatment and prognosis
Epiphrenic diverticula can be treated surgically with myomectomy or diverticulectomy.
- 1. Fasano NC, Levine MS, Rubesin SE et-al. Epiphrenic diverticulum: clinical and radiographic findings in 27 patients. Dysphagia. 2003;18 (1): 9-15. doi:10.1007/s00455-002-0075-2 - Pubmed citation
- 2. W. B. Seaman. Epiphrenic diverticula. AJR. 1973;119 (2): 266-276. AJR (abstract)
- 3. Aravinthan A, Nikolic M, Ouyang X et-al. The hidden cause of dysphagia-epiphrenic diverticulum and esophageal motility disorders. Can. J. Gastroenterol. 2012;26 (2): 68-9. Free text at pubmed - Pubmed citation
Synonyms & Alternative Spellings
|Synonyms or Alternative Spelling||Include in Listings?|
|Epiphrenic oesophageal diverticulum||✗|
|Epiphrenic oesophageal diverticula||✗|