Endoscopic esophageal reconstruction in epiphrenic diverticulum: septotomy-free diverticulectomy and suturing

Abstract

Epiphrenic diverticulum (ED) is a rare pulsion-type sac that typically develops secondary to esophageal motility disorders. Although surgical resection has been the standard treatment, advances in third-space endoscopy have introduced minimally invasive alternatives. We describe an endoscopic approach combining peroral endoscopic myotomy (POEM) with septotomy-free diverticulectomy and endoscopic suturing. Methods A 65-year-old man with spastic achalasia and ED underwent selective circular myotomy using the POEM technique. The diverticulum was inverted into the lumen, its neck closed with barbed sutures at the muscular layer, and subsequently resected from the luminal side using a polypectomy snare. The mucosal defect was closed with additional suturing. Results The procedure was completed without adverse events. Postoperatively, the diverticulum completely disappeared, and the patient's symptoms resolved. Follow-up endoscopy confirmed complete healing with no recurrence. Conclusions This combined technique restores the tubular anatomy of the esophagus and maintains luminal patency. Septotomy-free diverticulectomy with endoscopic suturing may represent a minimally invasive and effective alternative to surgery for select patients with EDs.