Epiphrenic diverticula are pulsion type diverticula that form in the distal portion of the esophagus, typically in the distal 10cm. They are quite uncommon, with an esti­mate incidence of 1in 500,000 per year [97]. Typically epiphrenic diverticula occur on the right side of the esophagus [98]. The rst description is attributed Hoxie in 1804 based on anatomical studies, and then radiographically by Zeitstein in 1898 [6]. Mondiere described symptoms attributed to epiphrenic diverticula and was the rst to postulate in 1833 that intraluminal pressure played a role in the development epi­phrenic diverticula [99]. Current understanding is the epiphrenic diverticula are pul­sion-type diverticula that result from herniation of the mucosa and submucosa through an intrinsic weakness in the esophageal wall. Similar to hypopharyngeal diverticula, most epiphrenic diverticula are related to an underlying motility disorder that results in a functional distal obstruction and hyper- pressurization of the esopha­geal lumen [24, 99, 100]. One group was able to perform barium videoesophagogra­phy, upper gastrointestinal endoscopy, and esophageal manometric in patients with symptomatic epiphrenic diverticula [98]. By performing this complement of studies, they were able to demonstrate that all of the patients had a concomitant motor abnor­mality, and were distributed across ve separate diseases: achalasia, diffuse esopha­geal spasm, hypertensive lower esophageal sphincter, nutcracker esophagus, and vigorous achalasia [98]. However, even in the absence of a diagnosed esophageal motility disorder, patients with epiphrenic diverticula will have alterations in the myenteric plexus leading to poor coordination of muscular contraction [101].