Esophageal Intramural Pseudodiverticulosis (EIP)

Esophageal intramural pseudodiverticulosis (EIP) is an uncommon, benign condition characterized by multiple tiny, flask-shaped openings (in barium esophagogram - outpouchings) (tiny diverticula) within the wall of the esophagus (1). These "pseudodiverticula" are actually dilated excretory ducts of the esophageal submucosal glands rather than true protrusions or diverticula of the mucosal layer through the muscle wall.

The condition involves the cystic dilation of submucosal gland ducts, often associated with chronic inflammation and periductal fibrosis. Most commonly diagnosed in the 6th and 7th decades of life, with a slight predilection for males. It is extremely rare, found in approximately 0.15% of barium swallow examinations (1, 2).

The outpouchings can be diffuse (60%) or segmental (40%). Segmental cases often occur in the upper esophagus, while recent studies also link mid-to-distal involvement with conditions like eosinophilic esophagitis (Eo E). EIP is associated with GERD, DM, chronic alcoholsm, tobacco use and esophageal dysmotility disorders (1-3).

Treatment is focused on the primary conditions. If the patient has associated stenosis dilation may be necessary (3).

References

1. Shintaku M. Esophageal intramural pseudodiverticulosis. World J Gastroenterol. 2024 Jan 14;30(2):137-145. doi: 10.3748/wjg.v30.i2.137. PMID: 38312118; PMCID: PMC10835521.

2. Hahne M, Schilling D, Arnold JC, Riemann JF. Esophageal intramural pseudodiverticulosis: review of symptoms including upper gastrointestinal bleeding. J Clin Gastroenterol. 2001 Nov-Dec;33(5):378-82. doi: 10.1097/00004836-200111000-00007. PMID: 11606853.

3. Hahne M, Schilling D, Arnold JC, Riemann JF. Esophageal intramural pseudodiverticulosis: review of symptoms including upper gastrointestinal bleeding. J Clin Gastroenterol. 2001 Nov-Dec;33(5):378-82. doi: 10.1097/00004836-200111000-00007. PMID: 11606853.

About the author

Klaus Mönkemüller, MD, PhD, FASGE, FJGES, FESGE

Editor-in-Chief, The Practicing Endoscopist

Professor of Medicine, Carilion Memorial Hospital / Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA

Klaus Mönkemüller, MD, PhD, FASGE, FJGES, FESGE, is the editor-in-chief of The Practicing Endoscopist and the founder of EndoCollab. He is Professor of Medicine at Virginia Tech Carilion School of Medicine and a practicing endoscopist at Carilion Memorial Hospital in Roanoke, Virginia.

Dr. Mönkemüller has published extensively on endoscopic techniques and devices, with a particular focus on therapeutic endoscopy, foreign body removal, GI bleeding, and the use of caps and accessories in everyday practice. He lectures internationally and has contributed to multiple GI endoscopy textbooks and atlases.

Save this article as a PDF

Drop your email and we'll open a print-ready version you can save as a PDF — and you'll start getting our weekly GI endoscopy newsletter.

← All articles