Post written by Yohei Nishikawa, MD, from the Digestive Diseases Center, Showa University Koto Toyosu Hospital, Showa University, Tokyo, Japan.

For esophageal diverticulum with symptoms, thoracoscopic or laparoscopic surgery is usually performed. We reported a case of an endoscopic esophageal diverticulum resection by applying the peroral endoscopic myotomy (POEM) and POEM + Fundoplication (POEM-F) techniques, which was equivalent to surgical treatments.

The case was a 47-year-old man who presented with reflux symptoms after meals. The patient was diagnosed with an epiphrenic diverticula with esophagogastric junction outflow obstruction. We suspected that direct reflux of food and saliva remaining in the diverticulum caused his reflux symptoms in addition to the obstruction. Hence, we performed standard POEM and endoscopic esophageal diverticulum resection.

In particular, the diverticulum was endoscopically dissected from the mediastinal pleura and pulled to adduct into the esophageal lumen. The muscle layer at the entry of the diverticulum was stitched together by endoscopic suturing method using an endoscopic needle holder. The inverted diverticulum was then removed using a snare, and the mucosal defect was closed with clips.

After the procedure, the patient started eating on the fourth day and was discharged on the seventh day. His reflux symptoms improved immediately.

This endoscopic esophageal diverticulum resection is the first case in the world. This procedure is an extension of POEM, POEM-F. Hence, we were able to perform this procedure in a minimally invasive and safe way. 

Recently, third space endoscopy is attracting the attention as the new frontier of endoscopic treatments. This procedure was devised by continuing advanced endoscopic treatments in our daily practice. This success may create further new treatments in the future. It is important to constantly consider new ideas and techniques from our precious daily experiences.

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