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Benign Esophageal Conditions

In addition to malignancies of the esophagus, a multitude of benign esophageal conditions do exist. While there are many different diagnoses, some of the more common diseases seen by thoracic surgeons are Zenker’s Diverticulum, Epiphrenic Diverticulum, Achalasia and Leiomyoma.

Zenker’s Diverticulum, also known as pharyngoesophageal diverticulum, is the most common diverticulum of the esophagus. A diverticulum is a pouching out of a hollow organ or tube, i.e. the esophagus or colon. Zenker’s diverticulum forms when the swallowing muscles become uncoordinated due to failure of relaxation of the cricopharyngeus muscle. When this muscle does not relax, it impedes the movement of food matter which should be propelled by the contraction of muscles.

Epiphrenic Diverticulum is a similar extrusion occurring just above the diaphragm at the lower part of the esophagus. Like Zenker’s, epiphrenic diverticula occur after the distal esophageal sphincter muscle fails to relax as the more proximal musculature contracts.

Symptoms for both types of diverticulum may include difficulty swallowing, pain on swallowing, bad breath, regurgitation of undigested foods, aspiration, or sometimes a generalized feeling of fullness or "pressure" in the neck or behind the breastbone (sternum). To diagnose divertriculum, a radiographic study of the esophagus (barium swallow) and/or endoscopy is performed.

Both conditions respond nicely to a combination of myotomy (cutting of the muscular pinchcock) and diverticulectomy (removal of the pertinent outpouching). Surgery for Zenker’s can be performed with either a small incision in the neck or using special instrumentation that is placed through the mouth and into the esophagus. There is not yet a minimally invasive approach to surgery for epiphrenic diverticula, thus surgery is performed through an incision in the chest.

Achalasia is another disease caused by uncoordinated contraction of the esophagus. In this case, the lower esophagus is unable to properly relax and allow passage of food into the stomach. This leads to food accumulation and progressive dilatation of the esophagus. Symptoms are usually chronic and include difficulty swallowing, regurgitation of undigested food, vague chest pains and heartburn. Diagnosis relies on evaluation of esophageal contractions (manometry) and a barium swallow and/or endoscopy.

There are many options to treating achalasia. Endoscopic treatments include balloon dilatation or botulinum toxin injection. Both achieve symptomatic relief for a limited period of time and demand multiple procedures. Surgery on the other hand offers the best chance for long term improvement. It can be performed by conventional open or minimally invasive techniques and entails an extensive myotomy plus an anti-reflux procedure called a partial fundoplication.

Leiomyoma is a type of benign esophageal tumor. Leiomyomas are smooth muscle tumors which originate in the muscular wall of the esophagus. They are usually asymptomatic when they do cause symptoms, most commonly patients complain of difficulty swallowing. Other benign tumors include lipomas and fibromas. Treatment of these tumors is by surgical enucleation, which means removing the tumor while leaving the remainder of the esophagus intact.

With locations throughout northern Virginia, CVTSA proudly serves patients in the DC, Maryland and Virginia area who need care for esophageal conditions.

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