A rare case of bilateral Killian-Jamieson diverticula treated endoscopically

A 68-year-old man presented with progressive dysphagia to solids and liquids, regurgitation of undigested food, and weight loss for the past three years. Upper gastrointestinal endoscopy followed by a barium esophagram revealed two contralateral diverticula in the cervical esophagus just below the cricopharyngeus. They measured 2 cm and 4 cm and were filled with food debris, consistent with two synchronous Killian-Jamieson diverticula ([Fig. 1]). After multidisciplinary evaluation, endoscopic treatment was proposed.

Fig. 1 Endoscopic view of the two Killian–Jamieson diverticula.

The procedure was performed under general anesthesia with endotracheal intubation. A submucosal bleb was created proximal to the diverticula in the posterior wall, followed by a 1.5-cm mucosal incision ([Video 1]). A submucosal tunnel was created, which was then extended to both the end of the larger diverticulum and the proximal esophagus ([Fig. 2]). Tunneling was continued until the bottom of the diverticulum was reached. The septum was thus entirely exposed and a complete septotomy was performed ([Fig. 3], [Fig. 4]). Finally, the mucosal incision was closed using six clips. The procedure took 60 minutes and there were no complications.

Video 1 Diverticular peroral endoscopic myotomy technique for the treatment of two Killian–Jamieson diverticula.

Fig. 2 Tunneling was performed along both sides of the septum to allow septum isolation.

Fig. 3 Complete septotomy was performed.

Fig. 4 Endoscopic view of the septum post-septotomy.

The patient progressed well and a post-procedural barium esophagram confirmed the absence of any extraluminal oral contrast leak. At 4 months after the procedure, the patient remains asymptomatic on a regular diet.

A Killian-Jamieson diverticulum is an unusual form of esophageal diverticulum arising from a muscular gap in the anterolateral wall of the proximal cervical esophagus [1]. It can present with symptoms similar to those of a Zenker’s diverticulum and presents anatomic challenges for any intervention, particularly owing to the high risk of injury to the recurrent laryngeal nerve [1]. Because of its rare incidence, treatment remains controversial [1]. Endoscopic therapies have been reported as safe and effective [1] [2] [3]. To the best of our knowledge, this is the first case of the use of the peroral endoscopic myotomy technique for the treatment of two Killian–Jamieson diverticula.

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Artikel online veröffentlicht:
02. Juli 2021

• References

• 1 Saisho K, Matomo S, Akagi Y. et al. Surgery for Killian-Jamieson diverticulum: a report of two cases. Surg Case Rep 2020; 6: 17
• 2 Yang D, Draganov P. Endoscopic Killian-Jamieson diverticulotomy using a scissor-type electrosurgical knife. Endoscopy 2018; 50: E175-E176
• 3 Miutescu B, Khan S, Khashab M. et al. Role of peroral endoscopic myotomy (POEM) in the management of esophageal diverticula. Clin Endosc 2020; 53: 646-651