Peroral Endoscopic Myotomy for Epiphrenic Diverticulum in a High-Risk Patient With Esophagogastric Junction Outlet Obstruction

Epiphrenic diverticula are rare and often debilitating, particularly when associated with esophagogastric junction outflow obstruction, and their management is challenging in high-risk surgical candidates. We describe a 77-year-old woman with severe dysphagia, regurgitation, and significant weight loss caused by a large distal epiphrenic diverticulum and esophagogastric junction outflow obstruction. Given her multiple comorbidities, she was not a surgical candidate and underwent peroral endoscopic myotomy with diverticulotomy. The procedure was completed safely, resulting in complete symptom resolution and normalization of her Eckardt score. This case highlights peroral endoscopic myotomy with diverticulotomy as a minimally invasive, anatomy-directed solution for complex esophageal diverticula.