Gastric Diverticulum

Diverticulum in the fundus of the stomach, seen at
retroflexion (the shaft of the endoscope is seen descending
through the esophagogastric junction at the 12 o'clock
position). The diverticulum was an incidental finding in a
72 year-old woman undergoing endoscopy.

Gastric diverticula are extremely rare and may be
congenital or acquired. When symptomatic, gastric
diverticula may cause pain, nausea, dysphagia, and
vomiting. Gastric diverticula may also be associated with
ectopic mucosa, ulcers, and neoplastic changes.

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Fundic Diverticulum

Diverticulum in the fundus of the stomach, seen at
retroflexion.

A gastric diverticulum is an unusual anomaly of the
alimentary tract. Of the two types, congenital and
acquired, the former is far more common. The majority of
congenital diverticula protrude from the posterior gastric
wall just inferior to the gastroesophageal junction. While
most gastric diverticula are asymptomatic, some are
associated with epigastric discomfort that can be medically
controlled. A distinct minority result in devastating
complications such as perforation or hemorrhage. The
preoperative diagnosis of a bleeding gastric diverticulum
mandates aggressive lavage and thorough endoscopy of
the stomach to include a retroflexed view of the cardiac
portion of the stomach. Surgical amputation of the bleeding
juxtacardiac diverticulum is the treatment of choice.

Antral Diverticula.

Prepyloric Deformities.

Shows prepyloric pseudodiverticulum. This may result from previous duodenal ulceration causing an adhesion to form between the bulb and the antrum.

Antral Bands

Generally, without clinical implication, but peculiar
endoscopic image that resemble a duplicated pylorus

Video Endoscopic Sequence 1 of 4.

Gastric Diverticulum

The gastric fundal diverticulae are rare. They can present with variable symptoms.

Gastric diverticulum (GD) is an outpouching of the gastric wall. GDs are rare and they are commonly detected incidentally during routine diagnostic testing. Prevalence ranges from 0.04% in contrast study radiographs and 0.01% - 0. 11% at oesophagogastrodeudenum (OGD). The incidence of gastric diverticulum is equally distributed between males and females and typically may present in the fifth and sixth decades. However it is worth mentioning that it may present in patients as young as 9 years old.

Video Endoscopic Sequence 2 of 4.

Symptoms of GD vary and can imitate those of other common disorders. It is important to note that most GD are asymptomatic but may present with a vague sensation of fullness or discomfort in the upper abdomen. Presenting complaint might also be the result of a major complication of GD. This includes acute upper gastrointestinal bleed or perforation.

Video Endoscopic Sequence 3 of 4.

Surgical resection is recommended when the diverticulum is large, symptomatic or complicated by bleeding, perforation or malignancy. Both open and laparoscopic resection yield good results.

Video Endoscopic Sequence 4 of 4.

A high clinical index of suspicion is needed to diagnose and effectively manage patients with gastric diverticulum. This condition typically present with a long history of vague symptoms such as upper abdominal pain and dyspepsia. It does not always resolve with PPIs and can even be missed on OGD or CT scanning. A focused investigation to look for this particular condition is needed to identify it and subsequently manage it.