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Esophageal intramural pseudodiverticulosis, a rare cause of stenosis
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CLINRE-1003; No. of Pages 2
Clinics and Research in Hepatology and Gastroenterology (2017) xxx, xxx—xxx
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Esophageal intramural pseudodiverticulosis, a rare cause of stenosis Leila Abbes a,1, Guillaume Perrod a,b,∗,1, Gabriel Rahmi a,b, Christophe Cellier a,b a
Service d’hépato-gastro-entérologie et d’endoscopie digestive, hôpital européen Georges-Pompidou, Assistance publique—Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France b Université Paris-Descartes, 15, rue de L’école-de-Médecine, 75006 Paris, France
KEYWORDS Esophageal pseudodiverticulosis; Esophageal stenosis; Esophageal stricture; Dysphagia
Clinical case A 53-year-old man with a medical history of tobacco and alcohol abuse, was referred to our department for dysphagia and weight loss in the past three months. The upper GI endoscopy showed honeycombed aspect with multiple small diverticular orifices in the esophageal wall and several esophageal strictures ranging from 35 to 25 cm from the dental arches (Fig. 1). The esophageal biopsies showed aspecific inflammation and the thoraco-abdominal contrast-enhanced computed tomography was normal.
∗
Corresponding author. Service d’hépato-gastro-entérologie et d’endoscopie digestive, hôpital européen Georges-Pompidou, Assistance publique—Hôpitaux de Paris, 20, rue Leblanc 75015 Paris, France. E-mail address: [email protected] (G. Perrod). 1 Authors share the same authorship.
An empiric therapy with esomeprazole 40 mg twice a day was initiated and patient was proposed to endoscopic bougienage because of the presence of several esophageal strictures. Procedure with CO2 insufflation was performed under fluoroscopy guidance and using Savary-Miller bougies up to 15 mm. Post-dilation endoscopic control showed severe mucosal dilacerations with muscularis exposition without perforation. One month later, dysphagia had completely disappeared and patient reported a weight gain of 2 kg. Pseudo-esophageal diverticulosis is a rare disease with few cases reported worldwide [1]. The etiology and pathogenesis remains unclear. Chronic irritation of esophageal submucosal glands by a chemical agent or infection is probably involved [2]. It affects mostly men (63%), aged between 50 and 70 years old, with alcohol and tobacco abuse. Dysphagia is often associated with stenosis development (50%) of the upper or middle esophagus. Proton pump inhibitors and Savary-Miller bougienage appear to be the most relevant treatments [3].
http://dx.doi.org/10.1016/j.clinre.2017.04.001 2210-7401/© 2017 Elsevier Masson SAS. All rights reserved.
Please cite this article in press as: Abbes L, et al. Esophageal intramural pseudodiverticulosis, a rare cause of stenosis. Clin Res Hepatol Gastroenterol (2017), http://dx.doi.org/10.1016/j.clinre.2017.04.001
+Model CLINRE-1003; No. of Pages 2
ARTICLE IN PRESS
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L. Abbes et al.
Figure 1 Esophageal intramural pseudodiverticulosis. A. Smooth staged strictures and diffuse intramural pseudodiverticulosis. B. Superficial dilaceration of the mucosa due to the passage of the gastroscope.
Disclosure of interest The authors declare that they have no competing interest.
References
[2] Chon YE, Hwang S, Jung KS, Lee HJ, Lee SG, Shin SK, et al. A case of esophageal intramural pseudodiverticulosis. Gut Liver 2011;5:93—5, http://dx.doi.org/10.5009/gnl.2011.5.1.93. [3] Halm U, Lamberts R, Knigge I, Mössner J, Zachäus M. Esophageal intramural pseudodiverticulosis: endoscopic diagnosis and therapy. Dis Esophagus 2014;27:230—4, http://dx.doi.org/10.1111/dote.12104.
[1] Herter B, Dittler HJ, Wuttge-Hannig A, Siewert JR. Intramural pseudodiverticulosis of the esophagus: a case series. Endoscopy 1997;29:109—13, http://dx.doi.org/10.1055/s-2007-1004084.
Please cite this article in press as: Abbes L, et al. Esophageal intramural pseudodiverticulosis, a rare cause of stenosis. Clin Res Hepatol Gastroenterol (2017), http://dx.doi.org/10.1016/j.clinre.2017.04.001
ARTICLE IN PRESS
CLINRE-1003; No. of Pages 2
Clinics and Research in Hepatology and Gastroenterology (2017) xxx, xxx—xxx
Available online at
ScienceDirect www.sciencedirect.com
IMAGE OF THE MONTH
Esophageal intramural pseudodiverticulosis, a rare cause of stenosis Leila Abbes a,1, Guillaume Perrod a,b,∗,1, Gabriel Rahmi a,b, Christophe Cellier a,b a
Service d’hépato-gastro-entérologie et d’endoscopie digestive, hôpital européen Georges-Pompidou, Assistance publique—Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France b Université Paris-Descartes, 15, rue de L’école-de-Médecine, 75006 Paris, France
KEYWORDS Esophageal pseudodiverticulosis; Esophageal stenosis; Esophageal stricture; Dysphagia
Clinical case A 53-year-old man with a medical history of tobacco and alcohol abuse, was referred to our department for dysphagia and weight loss in the past three months. The upper GI endoscopy showed honeycombed aspect with multiple small diverticular orifices in the esophageal wall and several esophageal strictures ranging from 35 to 25 cm from the dental arches (Fig. 1). The esophageal biopsies showed aspecific inflammation and the thoraco-abdominal contrast-enhanced computed tomography was normal.
∗
Corresponding author. Service d’hépato-gastro-entérologie et d’endoscopie digestive, hôpital européen Georges-Pompidou, Assistance publique—Hôpitaux de Paris, 20, rue Leblanc 75015 Paris, France. E-mail address: [email protected] (G. Perrod). 1 Authors share the same authorship.
An empiric therapy with esomeprazole 40 mg twice a day was initiated and patient was proposed to endoscopic bougienage because of the presence of several esophageal strictures. Procedure with CO2 insufflation was performed under fluoroscopy guidance and using Savary-Miller bougies up to 15 mm. Post-dilation endoscopic control showed severe mucosal dilacerations with muscularis exposition without perforation. One month later, dysphagia had completely disappeared and patient reported a weight gain of 2 kg. Pseudo-esophageal diverticulosis is a rare disease with few cases reported worldwide [1]. The etiology and pathogenesis remains unclear. Chronic irritation of esophageal submucosal glands by a chemical agent or infection is probably involved [2]. It affects mostly men (63%), aged between 50 and 70 years old, with alcohol and tobacco abuse. Dysphagia is often associated with stenosis development (50%) of the upper or middle esophagus. Proton pump inhibitors and Savary-Miller bougienage appear to be the most relevant treatments [3].
http://dx.doi.org/10.1016/j.clinre.2017.04.001 2210-7401/© 2017 Elsevier Masson SAS. All rights reserved.
Please cite this article in press as: Abbes L, et al. Esophageal intramural pseudodiverticulosis, a rare cause of stenosis. Clin Res Hepatol Gastroenterol (2017), http://dx.doi.org/10.1016/j.clinre.2017.04.001
+Model CLINRE-1003; No. of Pages 2
ARTICLE IN PRESS
2
L. Abbes et al.
Figure 1 Esophageal intramural pseudodiverticulosis. A. Smooth staged strictures and diffuse intramural pseudodiverticulosis. B. Superficial dilaceration of the mucosa due to the passage of the gastroscope.
Disclosure of interest The authors declare that they have no competing interest.
References
[2] Chon YE, Hwang S, Jung KS, Lee HJ, Lee SG, Shin SK, et al. A case of esophageal intramural pseudodiverticulosis. Gut Liver 2011;5:93—5, http://dx.doi.org/10.5009/gnl.2011.5.1.93. [3] Halm U, Lamberts R, Knigge I, Mössner J, Zachäus M. Esophageal intramural pseudodiverticulosis: endoscopic diagnosis and therapy. Dis Esophagus 2014;27:230—4, http://dx.doi.org/10.1111/dote.12104.
[1] Herter B, Dittler HJ, Wuttge-Hannig A, Siewert JR. Intramural pseudodiverticulosis of the esophagus: a case series. Endoscopy 1997;29:109—13, http://dx.doi.org/10.1055/s-2007-1004084.
Please cite this article in press as: Abbes L, et al. Esophageal intramural pseudodiverticulosis, a rare cause of stenosis. Clin Res Hepatol Gastroenterol (2017), http://dx.doi.org/10.1016/j.clinre.2017.04.001