title: Severe dysphagia due to a huge epiphrenic diverticulum: long-term treatment with balloon dilation and botulinum toxin injection: a case report.
abstract: We herein describe the first case of a high elderly patient with severe dysphagia in solids and liquids, caused by a huge epiphrenic diverticulum, who was treated with combined therapy of balloon dilation and botulinum toxin injection. Due to comorbid associated diseases the patient was unsuitable to withstand surgical or laparoscopic intervention. Treatment with botulinum toxin injection at the region of lower esophageal sphincter was unsuccessful. Combined therapy with balloon dilatation and botulinum toxin injection at the compressed part of esophageal lumen by the diverticulum resulted in improvement in dysphagia and malnutrition. During the long-term follow-up the patient developed symptomatic relapses, successfully treated by subsequent combined therapy resulting in longer-lasting symptom relief.
authors.affiliation: Department of Endoscopy and Motility Unit, "G. Gennimatas" General Hospital of Thessaloniki Ethnikis Aminis 41, Thessaloniki Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Katsinelos
authors.forename: Grigoris
authors.initials: G
authors.lastname: Chatzimavroudis
authors.forename: Kostas
authors.initials: K
authors.lastname: Fasoulas
authors.forename: Ioannis
authors.initials: I
authors.lastname: Pilpilidis
authors.forename: Georgia
authors.initials: G
authors.lastname: Lazaraki
authors.forename: Taxiarchis
authors.initials: T
authors.lastname: Katsinelos
authors.forename: Dimitris
authors.initials: D
authors.lastname: Tzilves
authors.forename: George
authors.initials: G
authors.lastname: Germanidis
authors.forename: Themistoklis
authors.initials: T
authors.lastname: Vasiliadis