Editing Oesophageal diverticulum (section)

== '''Epiphrenic diverticula''' ==

* Anatomy
** Distal third of oesophagus      (within 10cm of GOJ), adjacent to the diaphragm
** Mostly on the right side and      mostly wide-mouthed
* Pathophysiology
** Pulsion diverticula
** Related to thickened distal      oesophageal musculature or increased intraluminal pressure
** Associated with diffuse      oesophageal spasm, achalasia or hypertensive LOS disorders
** Can be seen in EDS or trauma      too
* Presentation
** Mostly asymptomatic
** Can have dysphagia or chest      pain, especially with an underlying motility disorder
* Diagnosis
** Barium swallow - identify      size, position and proximity to diaphragm
** Manometric studies for the      underlying disorder
** Gastroscopy to look for      mucosal lesions including Barrett's, oesophagitis and cancer
* Treatment
** Similar to midoesophageal      diverticula
** Generally, a myotomy is      necessary to treat the underlying pathology
** <2cm diverticula can be      suspended from vertebral fascia without being excised, and perform a      myotomy
** Diverticulectomy - use a      bougie to prevent narrowing the oesophagus, close muscle over excision      site, and perform a myotomy on the opposite oesophageal wall from the      level of the diverticulum to the LOS
** If a large hiatal hernia is      present, excise the diverticulum, perform a myotomy, and repair the      hernia (otherwise high incidence of reflux)
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[[Category:UGIS]]