Endoscopy 2020; 52(12): E456
DOI: 10.1055/a-1149-1261
E-Videos

Peroral endoscopic myotomy approach to treating a Killian–Jamieson diverticulum

Praneet Wander
Division of Gastroenterology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Queens, New York, USA
,
Arvind Trindade
Division of Gastroenterology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Queens, New York, USA
,
Petros C. Benias
Division of Gastroenterology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Queens, New York, USA
› Author Affiliations
 

A 58-year-old man presented with dysphagia to pills, most solids, and some liquids. He also complained of regurgitation of food, either immediately or after 1 – 2 hours. He underwent a barium esophagram, which identified a cervical outpouching, which on further review was at the level of the upper esophageal sphincter, anterior and right lateral, suggesting that this was in fact a Killian–Jamieson (KJ) diverticulum rather than the more common Zenker’s diverticulum. KJ diverticula present anatomic challenges for any intervention, particularly because of the high risk of injury to the recurrent laryngeal nerve, which enters the neck at its base.

An upper gastrointestinal endoscopy was performed, during which a large anterolateral diverticulum was noted, consistent with the patient’s esophagram. A wire was passed into the esophageal lumen to maintain orientation while the endoscope was reinserted with a clear distal cap alongside the wire. A transverse mucosal entry was created along the septum and the muscle was dissected and freed from both mucosal aspects of the diverticulum. A complete myotomy was created up to and beyond the apex to ensure complete resolution. Finally, the mucosal entry was closed with through-the-scope clips ([Video 1]). The patient did well and was able to be discharged on the same day. He has reported excellent symptomatic relief at follow-up visits.

Video 1 Peroral endoscopic myotomy approach to treating a Killian – Jamieson diverticulum.


Quality:

The use of a peroral endoscopic myotomy (POEM) technique for the treatment of Killian–Jamieson and Zenker’s diverticula represents a forward evolution of the endoscopic approach to these conditions. The main advantages of using the POEM technique over a traditional septotomy [1] [2] are the safety and precision with which the muscle can be dissected away from the adjacent structures and the ability to provide safe closure for the myotomy, which in this case was 4 – 5 cm in length.

Endoscopy_UCTN_Code_TTT_1AO_2AD

Endoscopy E-Videos
https://eref.thieme.de/e-videos

Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high
quality video and all contributions are
freely accessible online.

This section has its own submission
website at
https://mc.manuscriptcentral.com/e-videos


#

Competing interests

P. C. Benias is a consultant for Medtronic, Boston Scientific, Apollo Endosurgical, and Olympus America. A. Trindade is a consultant for Pentax Medical and Olympus America. P. Wander declares no conflict of interest.

  • References

  • 1 Lee CK, Chung IK, Park JY. et al. Endoscopic diverticulotomy with an isolated-tip needle-knife papillotome (Iso-Tome) and a fitted overtube for the treatment of a Killian-Jamieson diverticulum. World J Gastroenterol 2008; 14: 6589
  • 2 Tang SJ, Tang L, Chen E. et al. Flexible endoscopic Killian-Jamieson diverticulotomy and literature review (with video). Gastrointest Endosc 2008; 68: 790-793

Corresponding author

Petros C. Benias, MD
Long Island Jewish Medical Center, Division of Gastroenterology
Zucker School of Medicine at Hofstra/Northwell
Northwell Health System
270-05 76th Avenue, New Hyde Park
NY 11040
USA   
Fax: +1-718-470-5509   

Publication History

Article published online:
12 May 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

  • References

  • 1 Lee CK, Chung IK, Park JY. et al. Endoscopic diverticulotomy with an isolated-tip needle-knife papillotome (Iso-Tome) and a fitted overtube for the treatment of a Killian-Jamieson diverticulum. World J Gastroenterol 2008; 14: 6589
  • 2 Tang SJ, Tang L, Chen E. et al. Flexible endoscopic Killian-Jamieson diverticulotomy and literature review (with video). Gastrointest Endosc 2008; 68: 790-793