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Page 4 of 7 Herbella et al. Mini-invasive Surg 2020;4:82 I http://dx.doi.org/10.20517/2574-1225.2020.84

Figure 2. Laparoscopic resection of epiphrenic diverticulum (left). The operation also includes a myotomy and partial fundoplication,
[1]
either a Dor (a) or Toupet (b). Reproduced from Reference with permission by Springer
[20]
Allaix et al. compared the outcomes for resected versus non-resected diverticula in a multicenter study.
Among 13 patients, in seven the diverticulum was not excised. The reasons for this approach were small
size or technical reasons (the upper pole could not be safely dissected laparoscopically because it was too
far from the esophagogastric junction or because of severe adhesions). Similar symptomatic outcomes were
documented after 20 months.

If diverticulectomy is not necessary for symptomatic relief, endoscopic treatment for the motor disorder,
such as forceful dilatation of the cardia, per oral endoscopic myotomy may be an attractive option. Initial
results are promising, albeit mostly based on few case reports [17,21-23] .

Conservative treatment
[1]
Some ED are asymptomatic or present with few symptoms . This ED may be left untreated.
[18]
Some authors investigated the fate of untreated diverticula. Castrucci et al. followed up 13 patients for 64
months and showed no complications or worsening of pre-existing symptoms and no change in size (except
[24]
for one case). Zaninotto et al. followed up 16 patients for 46 months in whom the conservative approach
was followed because of the small size of the diverticula or the presence of severe comorbidities. Symptoms
were mostly unchanged. The same authors reviewed the literature with similar results reported by five other
[25]
studies .