Brief report
Flexible endoscopic Killian-Jamieson diverticulotomy and literature review (with video)

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Case report

A 51-year-old woman had a 3-month history of daily dysphagia to solid foods, especially bread. She reported a globus sensation posterior to the sternum. The patient denied odynophagia or medical or surgical histories. A barium swallow demonstrated a KJD about 2 cm distal to the upper esophageal sphincter (UES) within the left lateral wall of the esophagus (Fig. 1). The craniocaudal size of the diverticulum was estimated to be 15 mm and distal diverticular depth of 10 mm. There was a significant

Discussion

KJD is a rare disease and certainly has been misdiagnosed by endoscopy. From a literature review, we compared the anatomy, presenting symptoms, and radiographic and endoscopic finings of KJD and ZD (Table 1).1, 2, 3, 4 Endotherapy for ZD focuses on releasing the cricopharyngeal spasm by performing diverticulotomy on the septum.5, 6, 7, 8, 9, 10, 11, 12 Otolaryngologists have adopted rigid endoscopic stapler-assisted diverticulotomy.5, 6, 7 Adopting the rationale in stapler-assisted

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    The etiology of KJD is unknown, but current opinion suggests that it an acquired rather than congenital defect given that it often manifests in adulthood and with advancing age.2,10 The postulated pathogenesis for the development of KJD is possibly a combination of both structural weakness and some degree of dysmotility in the pharyngoesophageal junction.5 KJD is a rare esophageal diverticulum, with <30 publications in the English literature (mostly case reports) since the seminal paper by Ekberg and Nylander1 in 1983 and fewer reports on the surgical treatment (Table 1).

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    For foreign bodies impacted in the cervical esophagus, flexible endoscopy is probably more convenient. Diverticula are uncommon in the EI, and they generally are of 4 types: lateral pharyngeal or laryngopharyngeal diverticulum,31-34 Zenker's diverticulum,35-39 posttraumatic diverticulum or pseudodiverticulum,40 and Killian-Jamieson diverticulum41-43 (Video 2, available online at www.giejournal.org). Diverticula in the EI and esophagus are best studied by barium esophagram.

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    Differentiation from the less common, and smaller, Killian-Jamieson diverticulum that arises from the proximal anterolateral cervical esophagus and lies inferior to the CP muscle is important. Although Killian-Jamieson diverticula may be treated endoscopically,25 it is unclear if the efficacy and safety are the same as with ZD, as the recurrent laryngeal nerve runs close to the base of the diverticulum. Various radiologic correlations to ZD progression and predictors to therapy have been described.

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