An elegant alternative to surgery for the management of an epibronchial esophageal diverticulum

Text We present a volumous 5cm epibronchial esophageal diverticulum which, due to high rates of expected surgery associated morbi-mortality, was managed by diverticular peroral endoscopic miotomy (D-POEM). Upon removal of abundant food residue inside the diverticulum, a submucosal bleb was created 25mm proximally to the septum’s diverticulum, where a 15-20mm extension mucosotomy was made. A submucosal tunnel was created which was then extended to both the end of the diverticulum and the esophagus, thus isolating the septum. Complete septum miotomy was then performed. The mucosal incision was then completely closed using hemoclips.