ENDOSCOPIC TREATMENT OF A DIVERTICULAR OESOPHAGEAL DUPLICATION

Aims:

Oesophageal duplications are rare congenital malformations, presenting as cystic, tubular or diverticular. Oesophageal duplications can remain asymptomatic for decades, and clinical manifestations can occur at any moment.

Methods:

We present the case of a 24-year-old man with an oesophageal duplication, who received successful endoscopic treatment.

The patient, with mental retardation, had a history of dysphagia since the childhood. Dysphagia worsened recently, and was associated with regurgitation and abdominal pain. For this reason, he underwent barium oesophagram and esophagogastroduodenoscopy that showed a paraesophageal diverticulum suggestive for diverticular oesophageal duplication.

Open surgery was attempted, but eventually the diverticulum was not excised, being the resection considered too dangerous.

The patient was thus referred to our Unit.

Preliminary esophagogastroduodenoscopy confirmed the presence of a diverticulum, extended for 7 cm, and starting at 35 cm from the upper incisors. A cap-assisted septotomy was performed. The endoscopic procedure was done with the patient supine, under general anaesthesia. The septum between the original oesophageal lumen and the diverticulum was carefully cut with a needle-knife.

At the end of the procedure, endoscopic clips were placed at the base of incision, to prevent bleeding and perforation.

Results:

Post-operative course was uneventful. A water-soluble contrast study on first post-operative day confirmed the absence of leakages or stasis into the diverticulum. On second post-operative day the patient started oral feeding and, two days later, he was discharged.

Six months after the treatment he is in good clinical conditions, having normal diet, without dysphagia or regurgitation.

Conclusions:

To our knowledge, this is the first report of a completely endoscopic treatment of diverticular oesophageal duplication. The procedure was relatively easy and extremely rapid. Recovery after the operation was very quick, with an early oral feeding. This procedure should probably be considered as first line therapy of this rare disorder.