Esophageal epiphrenic diverticula (ED) are uncommon; they tend to be associated with motility disorders. The natural history of ED is not entirely clear and the decision whether to operate or not is often based on the personal preference of the physician and patient. The aim of this study was to evaluate the long-term fate of operated and unoperated ED patients. Clinical, radiological and motility findings, operative morbidity and long-term outcome of 37 ED pts referred from 1993 to June 2005 were analyzed. All pts were reviewed at the outpatients clinic or interviewed over the phone. A symptom score was calculated using a standard questionnaire and subjective patient assessments. 20 pts (10M:10F, median age 60 years) were operated. One pt underwent surgery for spontaneous rupture of a large ED. Operative mortality was nil; postoperative morbidity was 26%, the most severe complication being suture leakage (4 pts, managed conservatively). The median follow-up was 53 mos. 18 pts (7M:11F, median age 70 years) were not operated. 2 pts received pneumatic dilations. The median follow-up was 37 mos. No patients in either group died for reasons related to their ED. Recurrent ED was observed in 1 pt. Four pts in the operated group had GERD symptoms and/or esophagitis. Surgery is an effective treatment for ED, but carries a significant morbidity, mainly related to suture leakage. Even in the long term, unoperated patients do not die of their ED, though a better subjective symptom outcome is reported by operated patients. A non-interventional policy can safely be adopted for cases of small, mildly symptomatic ED.
Clinical findings

* Better compared to worse or unchanged (operated vs. non operated, p=0.0002)