Simultaneous treatment of concomitant achalasia coexisting with epiphrenic diverticulum: The practice of submucosal tunneling technique

Table 1 Clinical characteristics

Characteristics	ED + S (n = 21)	ED - S (n = 10)
Age (years)	50 (13-77)	46.4 (19-77)
Sex
Male	8 (38.1)	4 (40.0)
Female	13 (61.9)	6 (60.0)
BMI (kg/m2)	20.4 (15.6-26)	22.1 (16.9-27.8)
Ling classification
Ling IIIR	11 (52.4)	5 (50.0)
Ling IIIL	8 (38.1)	3 (30.0)
Ling IIILR	2 (9.5)	2 (20.0)
EMIA classification
A	7 (33.3)	4 (40.0)
B	9 (42.9)	4 (40.0)
C	3 (14.3)	1 (10.0)
D	2 (9.5)	1 (10.0)
SMF classification
A0	2 (9.5)	0
A1	9 (42.9)	2 (20.0)
A2	9 (42.9)	7 (70.0)
A3	1 (4.7)	1 (10.0)
Disease course (months)	109 (1-360)	208 (16-840)
Patients with prior treatment
Pneumatic balloon dilation	2 (9.5)	0
Botulinum toxin injection	2 (9.5)	1 (10.0)
Per-oral endoscopic myotomy	1 (4.7)	2 (20.0)
Heller myotomy	0	4 (40.0)
Chicago classification
Type I	3 (14.3)	7 (70.0)
Type II	14 (66.7)	3 (30.0)
Type III	1 (4.7)	0
Missing	3 (14.3)	0
IRP (mmHg)	30.9 (13-58.2); n = 9	26.4 (16.7-36.0); n = 2
24-hour esophageal pH monitoring
Pathological reflux	0	0
Acid fluid retention	3 (14.3)	1 (10.0)
Normal	9 (42.9)	9 (90.0)
Missing	9 (42.9)	0

Data are shown as median (range) or n (%). DE + S: Epiphrenic diverticulum with septum; DE - S: Epiphrenic diverticulum without septum; BMI: Body mass index; EMIA: Esophageal mucosa in achalasia classification; SMF: Submucosal fibrosis; IRP: Integrated relaxation pressure.

Table 2 Procedure-related characteristics and complications

Characteristics	DE + S (n = 21)	DE - S (n = 10)
Technical success	21 (100)	10 (100)
Length of tunnel (cm)	9.3 (6-13)	9.7 (7-12)
Length of myotomy (cm)	7.1 (5-10)	7.0 (5-10)
Types of myotomy
Progressive full-thickness myotomy	17 (81.0)	7 (70.0)
Full-thickness myotomy	4 (19.0)	3 (30.0)
Distance from the cardia (cm)	1.8 (1-5)	0
Procedure time (minutes)	61 (26-123)	58.4 (22-128)
Hospital stays after operation (days)	6.8 (4-11)	7.0 (4-12)
Complications
Mucosa injury	2 (9.5)	0
Gas-related adverse event	0	0
Bleeding	0	0

Data are shown as median (range) or n (%). DE + S: Epiphrenic diverticulum with septum; DE - S: Epiphrenic diverticulum without septum.

Table 3 Long-term outcomes of the epiphrenic diverticulum with septum group, median (interquartile range)

Eckardt score (n = 18)	Pre-operation	Post-operation	P value
Dysphagia	3.0 (1.75-3.0)	0 (0-1.0)	< 0.05
Chest pain	0 (0-0.25)	0 (0-0)	0.083
Regurgitation	2.0 (1.0-3.0)	0 (0-1.0)	< 0.05
Weight loss	1.0 (0-3.0)	0 (0-0)	< 0.05
Eckardt score	6.0 (4.0-8.0)	0(0-2.0)	< 0.05

Table 4 Long-term outcomes of the epiphrenic diverticulum without septum group, median (interquartile range)

Eckardt score (n =10)	Pre-operation	Post-operation	P value
Dysphagia	2.5 (2.0-3.0)	1.0 (0-1.25)	< 0.05
Chest pain	1.0 (0-1.0)	0 (0-0.25)	< 0.05
Regurgitation	1.5 (0-2.0)	0 (0-1.0)	< 0.05
Weight loss	2.5 (0.75-3.0)	0 (0-0)	< 0.05
Eckardt score	6.0 (3.75-8.25)	1.0 (0-3.0)	< 0.05

Table 5 Clinical reflux evaluation, n (%)

Clinical reflux evaluation	ED + S (n = 18)	ED - S (n = 10)
GERD-Q score
≥ 8	3 (16.7)	2 (20.0)
< 8	15 (83.3)	8 (80.0)
Endoscopic monitoring	n = 6	n = 5
Reflux esophagitis by gastroscopy	4 (66.7)	1 (20.0)
LA-A	3 (50)	0
LA-B	1 (16.7)	0
LA-C	0	1 (20.0)

DE + S: Epiphrenic diverticulum with septum; DE - S: Epiphrenic diverticulum without septum; GERD-Q: Gastroesophageal Reflux Disease Questionnaire; LA: Los Angeles.