Mid-esophageal diverticulum is caused by altered motility which results in abnormal intraluminal pressure and the pushing of the esophageal mucosa through focal weaknesses of the muscular wall. Mid-esophageal diverticulum is usually asymptomatic[4],and symptoms, such as dysphagia, regurgitation, heartburn, halitosis and weight loss, result from underlying motility disorders. The treatment methods for esophageal diverticulum include surgery, and thoracoscopic, and diverticular peroral endoscopic myotomy.
D-POEM is a reproducible technique which utilizes a tunnel under the esophageal mucosa to cut the ridge between the diverticulum and preserve the esophageal mucosa. The unique feature of this technique in the treatment of esophageal diverticulum is that it can fully expose the diverticulum diaphragm, making it possible to open the diaphragm completely under endoscopic vision, thus reducing recurrence rate[5]. Yang et al[5] reported that the technical success of D-POEM was 85.70% for Zenker’s diverticulum, 100% for mid-esophageal esophageal diverticulum, and 100% for epiphrenic esophageal diverticulum. In our case, the patient suffered from dysphagia for eight years. The symptoms disappeared after D-POEM surgery, and no postoperative complications such as bleeding, infection, and subcutaneous emphysema occurred. The advantages of D-POEM in treating esophageal diverticulum include: 1. being able to close the entrance using the clip to preserve the complete mucosa to prevent perforation, which can effectively avoid the occurrence of esophageal fistula, pneumothorax, and empyema; and 2. Complete incision of the diverticulum diaphragm can reduce the recurrence rate of esophageal diverticulum to some extent.
In summary, D-POEM may be a safe and effective treatment for esophageal diverticulum, and has significant short-term efficacy. Follow-up and additional case studies are required to validate the long-term efficacy.