Long-term botulinum toxin treatment for dysphagia due to large epiphrenic diverticulum in elderly patients: a report of two cases.

Symptomatic esophageal epiphrenic diverticula are usually repaired with diverticulectomy and esophagomyotomy with substantial morbidity and mortality rates, especially in elderly patients. We describe the cases of two elderly patients who had dysphagia caused by large epiphrenic diverticula. Due to severe comorbid diseases, both patients were unable to withstand surgical intervention; botulinum toxin solution was injected endoscopically at multiple sites in the region of the lower esophageal sphincter and esophageal wall near the diverticulum. Symptoms improved immediately and the beneficial effect of botulinum toxin remained for 5-6 months. During the long-term follow-up, the patients developed symptomatic relapses treated by subsequent botulinum toxin solution reinjections resulting in longer-lasting symptom relief.