Clinical and endoscopic characteristics of diffuse esophageal intramural pseudo-diverticulosis
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ORIGINAL ARTICLE
Clinical and endoscopic characteristics of diffuse esophageal intramural pseudo‑diverticulosis Florian Hentschel1,2 · Stefan Lüth1 Received: 26 September 2019 / Accepted: 24 February 2020 © The Author(s) 2020
Abstract Introduction With 250 published cases worldwide, diffuse esophageal intramural pseudo-diverticulosis (DEIPD) is a poorly understood disease. The aim of this study was to determine the prevalence of DEIPD in our own population, identify risk factors and clinical symptoms, and characterize its typical endoscopic signs. Methods Retrospective search in our center’s endoscopic and clinical database. Reviewing of all cases by re-examining stored endoscopic photographs. Reviewing of all cases regarding age, sex, risk factors, comorbidities, histology, and clinical symptoms. Results In a population of 150.000 we found 21 cases of DEIPD. Mean age was 56 ± 10 years. 86% were males, 76% had alcohol abuse, 57% had nicotine abuse, 38% had arteriosclerosis, 33% had COPD, 29% had malignancies, 24% had liver cirrhosis, 19% had impaired kidney function, and 15% had diabetes. Dysphagia was present in 62% and food bolus impaction (single or repeated) in 48%. Endoscopically, 95% of patients had multiple (> 4), small (0.25–2.5 mm) pseudodiverticle openings in the esophageal wall. In 62%, openings were aligned longitudinally. 86% showed edematous swelling of mucosa (“frosted glass look”), 76% showed a fine-grained pattern of small (10–100 µm) red dots (“faux uni pattern”), and 76% had a rigid, narrow lumen with multiple rings (“trachealization”). Conclusion With a prevalence of approximately 5 to 50/100.000, DEIPD may be more frequent than previously estimated. It preferably affects middle-aged male alcoholics. Key symptoms are chronic dysphagia and food impaction. Typical endoscopic findings are multiple, small, longitudinally aligned pseudodiverticle openings, frosted glass look, faux uni pattern, and trachealization of the esophagus. Keywords Rare diseases · Esophagus · Pseudodiverticulosis · Endoscopy · Esophageal inflammation · Candidiasis Abbreviations DEIPD Diffuse esophageal intramural pseudo-diverticulosis EGD Esophago-gastro-duodenoscopy EIPD Esophageal intramural pseudo-diverticulosis (used sysnonymusly) Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10388-020-00729-6) contains supplementary material, which is available to authorized users. * Florian Hentschel f.hentschel@klinikum‑brandenburg.de 1
Center for Internal Medicine II, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
Zentrum für Innere Medizin II, Hochschulklinikum Brandenburg der MHB, Hochstr. 29, 14770 Brandenburg an der Havel, Germany
2
EoE Eosinophilic esophagitis GERD Gastroesophageal reflux disease H&E Hematoxilin & eosin lp/mm Line points per millimeter SD Standard deviation
Introduction Diffuse esophageal intramural pseudo-diverticulosis (DEIPD) is a rare disease characterized by chronic inflammation and scarring of the
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