Endoscopic peroral esophagocardiomyotomy in the treatment of a patient with Barsson—Teschendorf syndrome and multiple epiphrenic diverticula

Background. Barsony—Teschendorf syndrome is characterized by the presence of segmental non-propulsive contractile waves occurring simultaneously at different levels regardless of the pharynx, which is a key factor in the development of esophageal diverticula. Epiphrenic diverticulum is a rare disease, which accounts for about 0.015% of esophageal diseases. For a long period of time, surgical treatment of patients with esophageal diverticula implied open diverticulectomy or laparo-thoracoscopic diverticulectomy. However, it should be noted that these interventions are characterized by a relatively high level of postoperative complications and a significant mortality rate. Over the past decade, in the clinical practice of leading surgical clinics, intraluminal endoscopic intervention — endoscopic peroral esophagocardiomyotomy — has increasingly been considered as the operation of choice for esophageal diverticula. Clinical case. A 73-year-old patient was treated at the Vishnevsky National Research Medical Center for diffuse esophagospasm and epiphrenal diverticula of the esophagus. Results. In our clinical observation, we obtained a convincing clinical result in the treatment of a patient with Barsony-Teschendorf syndrome and epiphrenic diverticula. The performed extended endoscopic peroral esophagocardiomyotomy allowed not only to get rid of the disease, which is difficult to treat surgically, but also to radically improve the quality of life. Conclusion. The intraluminal endoscopic approach to the treatment of patients with epiphrenic diverticula of the esophagus is an optimal, modern technique and a preferable alternative to traditional surgical diverticulectomy, since it is a pathogenetically significant method that improves the function of the esophagus in neuromuscular disease. The key to the success of endoscopic peroral esophagocardiomyotomy in achieving high efficiency and low recurrence is an extended myotomy of the esophagus.