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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(01): E119-E126
DOI: 10.1055/a-1548-5552
Original article

Endoscopic diverticulotomy for Killian-Jamieson diverticulum: mid-term outcome and description of an ultra-short tunnel technique

Rani J. Modayil
1   Department of Gastroenterology, Hepatology, and Nutrition, NYU-Winthrop Hospital, Mineola, New York, United States
,
Xiaocen Zhang
2   Department of Medicine, Mount Sinai St Luke’s-West Hospital Center, New York, New York, United States
,
Mohammad Ali
1   Department of Gastroenterology, Hepatology, and Nutrition, NYU-Winthrop Hospital, Mineola, New York, United States
,
Kanak Das
1   Department of Gastroenterology, Hepatology, and Nutrition, NYU-Winthrop Hospital, Mineola, New York, United States
3   Department of Medicine, division of Gastroenterology, University of Missouri Health Care, University of Missouri, Columbia, Missouri, United States
,
Krishna Gurram
4   Division of Gastroenterology and Hepatology, Elmhurst Hospital- Mount Sinai, Elmhurst, New York, United States
,
Stavros N. Stavropoulos
1   Department of Gastroenterology, Hepatology, and Nutrition, NYU-Winthrop Hospital, Mineola, New York, United States
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Abstract

Background and study aims Killian-Jamieson Diverticulum (KJD) is a rarer and more recently described upper pharyngeal diverticulum than Zenker’s diverticulum (ZD). KJD is more difficult to manage than ZD because it tends to extend lower into the upper mediastinum and the diverticulum neck is in close proximity to the recurrent laryngeal nerve. There is limited literature on KJD management and transcervical surgical diverticulectomy is the mainstay of therapy.

Patients and methods Here we describe two methods of endoscopic diverticulotomy to treat KJD – direct and tunneling diverticulotomy (with hypopharyngeal tunnel or ultra-short tunnel – the latter being our preferred technique).

Results This was a retrospective study including 13 consecutive patients between March 2015 and April 2018. Three patients received direct and 10 received tunneling diverticulotomy (7 with the hypopharyngeal tunnel and 3 with the ultra-short tunnel). All procedures were completed in 16 to 52 minutes. There was no incidence of bleeding, mediastinitis, or sign of recurrent laryngeal nerve injury. At follow up of 9 to 79 months (median 33), the clinical success rate was 92 % (12/13); 11 patients had complete symptom resolution (post-operative symptom score = 0) and one patient had near-complete symptom resolution (occasional residual dysphagia). One patient receiving direct myotomy had limited symptom relief (frequent residual dysphagia and occasional residual regurgitation), possibly related to incomplete myotomy.

Conclusions Endoscopic tunneling diverticulotomy is a feasible, safe, and effective method to treat KJD.



Publikationsverlauf

Eingereicht: 24. März 2020

Angenommen: 24. Juni 2021

Artikel online veröffentlicht:
14. Januar 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
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