Vishal Ghevariya, MD from the Icahn School of Medicine at Mount Sinai in Elmhurst, New York presents this VideoGIE case “Esophageal intramural pseudodiverticulosis.”
Esophageal intramural pseudodiverticulosis (EIPD) is a condition characterized by the development of numerous epithelium lined cystic foci or diverticulum within the esophageal wall. Progressive dysphagia and chest discomfort are the most common presenting complaints. Patients often exhibit clinical/laboratory features of chronic alcoholism, liver disease, and malnutrition. The disease presents as diffuse or localized thickening of the esophagus. The distal esophagus is the most common location of the stricture formation. EIDP can result in adverse events such as secondary fungal infection (candida most common), esophagopleural and esophagopulmonary fistula, mediastinitis and pseudodiverticular perforation.
Our patient was initially treated with oral proton pump inhibitor (PPI) and antifungal therapy without improvement. Endoscopic dilation was performed with some symptomatic improvement. However, her clinical course was complicated with esophagopulmonary fistula and lung abscess. The fistula was treated with drainage and covered metal stent placement. The patient improved as expected and reported no symptoms and weight gain to her baseline.
EIPD is a rare condition with significant impact on quality of life. Endoscopic dilation is indicated once medical management fails. EIPD can result in drastic adverse events and endoscopic therapy plays a vital role in the management of complications. Our video demonstrates various stages of treatment of EIPD and readers would benefit learning from our recommendations.
Covered metal stents are increasingly used for benign esophageal diseases. EIPD and resultant complications such as fistula formation can be treated effectively with covered metal stents.
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