Intramural pseudodiverticulosis of the esophagus detected on barium esophagograms: increased prevalence in patients with esophageal carcinoma

We tested the hypothesis that intramural pseudodiverticulosis of the esophagus is more prevalent in patients with esophageal carcinoma than in randomly selected patients who undergo esophagography for other indications. Such an association would prompt a careful search for carcinoma after esophageal intramural pseudodiverticulosis is found. Single- and double-contrast esophagograms of 245 patients with esophageal carcinoma were retrospectively reviewed. A control group of 6400 esophagograms obtained for indications other than esophageal carcinoma was also reviewed. The statistical significance of the difference in prevalence of esophageal intramural pseudodiverticula between patients with esophageal carcinoma and the control group was tested using the chi-square test. The significance of difference between the number of esophageal intramural pseudodiverticula in patients with esophageal dilatation and the number in those without dilatation was tested using a small-sample nonparametric test. Intramural pseudodiverticulosis of the esophagus was found in 11 patients with esophageal carcinoma (4.5%) and in six control subjects (0.09%). Intramural pseudodiverticulosis of the esophagus was present opposite the tumor as well as both proximally and distally. The number of cases of intramural diverticulosis in patients with esophageal carcinoma and dilatation was not significantly higher than that in patients with carcinoma but without dilatation (p > .1) The prevalence of esophageal intramural pseudodiverticulosis is significantly higher in patients with esophageal carcinoma than in patients who underwent esophagography for other indications (p < .0002). This association implies increased risk of esophageal carcinoma in patients with intramural pseudodiverticulosis. Periodic surveillance of patients with intramural pseudodiverticulosis of the esophagus for esophageal carcinoma may be worthwhile.