Esophageal intramural pseudodiverticula with endoscopic and radiographic demonstration of intramural trackings - 23/08/11
Doi : 10.1016/j.gie.2009.03.019
| Commentary Esophageal intramural pseudodiverticulosis (EIP) is an uncommon condition described by Mendel in 1960. EIP is defined by multiple, flask-shaped outpouchings in the wall of the esophagus, which represent the dilated excretory ducts of esophageal submucosal glands; such dilatation might be caused by ductal blockage from inflammatory debris or extrinsic compression due to periductal inflammation and fibrosis. EIP is most often documented radiologically as tiny collections of barium projecting beyond the esophageal wall. No symptoms are attributable directly to EIP, but dysphagia and other symptoms are likely due to associated motility disorders, strictures, and reflux. Indeed, current data suggest that pseudodiverticulosis is not a primary disease of the esophagus but an acquired consequence of chronic irritation. As far as the communication among diverticula is concerned, intramural tracking on esophagography has been noted in up to 50% of cases. Tracks range in appearance from short, thin bridges between 2 or more adjoining pseudodiverticula to long, intramural collections of barium that parallel the lumen; the latter must be distinguished from deep ulcers and from perforating fistulae, which may even result in mediastinal abscess or communicate with the bronchi. Both intramural tracking and EIP have a variable appearance over time, although disappearance of the tracks and pseudodiverticula actually may not reflect resolution but, rather, plugging of these structures with debris, thereby preventing them from filling with barium. EIP itself has no specific treatment, but symptomatic associations are treated, eg, dilation of strictures and proton pump inhibitor therapy for acid reflux. In the present case, the diverticula are inexplicably larger than the typical diverticulum of EIP. Does size matter? Apparently not for EIP. Lawrence J. Brandt, MD Associate Editor for Focal Points |
© 2009
American Society for Gastrointestinal Endoscopy. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
Vol 70 - N° 2
P. 383-385 - agosto 2009 Ritorno al numero
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