Long-term outcome of operated and unoperated epiphrenic diverticula.
BACKGROUND
The natural history of esophageal epiphrenic diverticula (ED) is not entirely clear; the decision whether to operate or not is often based on the personal preference of the physician and patient. The aim of this study was to evaluate the long-term fate of operated and unoperated patients with ED.


METHODS
Clinical, radiological, and motility findings, and operative morbidity and long-term outcome of 41 patients with ED (January 1993 to December 2005) were analyzed. All patients were reviewed at the outpatient clinic or interviewed over the phone. A symptom score was calculated using a standard questionnaire and subjective patient assessment. The radiological maximum diameter of the ED was measured.


RESULTS
Twenty-two patients (12M:10F; median age, 60 years) were operated. One underwent surgery for spontaneous rupture of a large diverticulum. Operative mortality was nil; postoperative morbidity was 22.7%, the most severe complication being suture leakage (4 patients, all managed conservatively); median follow-up was 53 months. Nineteen patients (9M, 10F; median age 70 years) were not operated: 3 received pneumatic dilations; median follow-up was 46 months. None of the patients in either group died for reasons related to their ED. Symptoms decreased in all operated patients and, to a lesser extent, also in unoperated patients. ED recurrence was observed in one operated patient. Four patients had GERD symptoms with esophagitis and/or positive pH-metry after surgery and 3 patients had persistent dysphagia/regurgitation and were dissatisfied with the outcome of surgery.


CONCLUSIONS
Surgery is an effective treatment for ED, but carries a significant morbidity related mainly to suture leakage. Even in the long-term, unoperated patients do not die of their ED, though a better subjective symptom outcome is reported by operated patients. A non-interventional policy can safely be adopted in cases of small, mildly symptomatic ED.
Zaninotto
Giovanni
G
General Surgery, Venice Hospital, ULSS12, University of Padova School of Medicine, Via Giustiniani 2, 35128, Padova, Italy. giovanni.zaninotto@unipd.it
Portale
Giuseppe
G
Costantini
Mario
M
Merigliano
Stefano
S
Guirroli
Emanuela
E
Rizzetto
Christian
C
Rampado
Sabrina
S
Ancona
Ermanno
E
D000368:Aged; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D004936:Diverticulum, Esophageal / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D015154:Esophageal Motility Disorders / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology; D011336:Probability; D054328:Proton Pump Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome
D054328:Proton Pump Inhibitors