Large symptomatic esophageal diverticulum.

A 72-year-old woman was referred from primary care to the gastroenterology clinic because of heartburn and occasional dysphagia for the last 8 years, with some isolated food regurgitation events and no other warning signs; she is currently asymptomatic on omeprazole. Gastroscopy revealed a dilated esophagus and food remnants with inability to reach the gastric lumen, which led to the suspicion of achalasia. The study was completed with pH-metry, which found no pathological reflux; esophageal manometry, with absence of esophageal motor abnormalities; and barium swallow, which revealed a large diverticulum on the posterior wall of the lower third of the esophagus, which had food remnants but no other changes or evidence of achalasia. Given these findings, a repeat gastroscopy was carried out that revealed a large diverticulum in the distal third of the esophagus that occluded 50 % of the esophageal lumen, with a length of 4-5 cm and abundant semi-liquid food remnants; upon aspiration of the latter a whitish mucosa with erythematous areas was revealed, as well as a 1.5-cm sliding hiatal hernia. No changes were found on advancing to the second duodenal portion. In view of the above findings and symptoms, the patient was referred to the surgery department to be evaluated for diverticulectomy.

[New techniques to extract impacted partially covered metallic biliary stents]. / Nuevas técnicas para extraer prótesis biliares metálicas recubiertas impactadas.

One of the problems affecting metallic biliary stents is the difficulty of removing them, especially after a period of months or if they have migrated. Several approaches have been used to remove both covered and uncovered stents, although with different degrees of effectiveness. We report two new approaches to removing partially covered stents that migrated proximally and that impacted in the papillary area and distal common bile duct. One stent was removed by papillectomy and the other by using duodenoscopy-guided controlled radial expansion balloon dilation. In both cases, the stents were removed without severe complications for the patient, leaving a good caliber in the stenosis.