Per-oral endoscopic myotomy and simultaneous diverticuloseptotomy in coincident epiphrenic diverticulum and achalasia Torsten Beyna, MD, Jennis Kandler,

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Per-oral endoscopic myotomy and simultaneous diverticuloseptotomy in coincident epiphrenic diverticulum and achalasia Torsten Beyna, MD, Jennis Kandler, MD, Horst Neuhaus, MD, PhD VideoGIE Volume 4, Issue 2, Pages 62-65 (February 2019) DOI: 10.1016/j.vgie.2018.09.019 Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 1 A, Coronary CT scan. B, Contrast esophagogram. C, Endoscopic aspect of a large epiphrenic diverticulum (after endoscopic cleaning from food) and narrow lumen of the distal esophagus and the esophagogastric junction. VideoGIE 2019 4, 62-65DOI: (10.1016/j.vgie.2018.09.019) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 2 High-resolution manometry (HRM) after endoscopic positioning of the probe: integrated relaxation pressure (IRP) with 23.2 mm Hg (<15 mm Hg) slightly elevated and reduced relaxation rate of the lower esophageal sphincter (LES=“UÖS”) with 59% (>60%). However, the Chicago criteria for achalasia are not totally met. IBP, intra-bolus pressure; DL, distal latency; DCI, distal contraction integral; PCV/PCP, proximal contraction wave velocity/pressure; DCV/PCV, distal contraction wave velocity/pressure. VideoGIE 2019 4, 62-65DOI: (10.1016/j.vgie.2018.09.019) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 3 A, Myotomy (red) and septotomy (yellow) are completely performed. B, Endoscopic view of submucosal tunnel and diverticulum after complete myotomy of the proper muscle layer and the septum. VideoGIE 2019 4, 62-65DOI: (10.1016/j.vgie.2018.09.019) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 4 Postinterventional contrast esophagogram shows quick passage of contrast medium through the esophagogastric junction into the stomach; the previously large diverticulum has collapsed and shows no leakage. VideoGIE 2019 4, 62-65DOI: (10.1016/j.vgie.2018.09.019) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions