Endoscopic diverticulotomy with an isolated-tip needle-knife papillotome (Iso-Tome) and a fitted overtube for the treatment of a Killian-Jamieson diverticulum.
A Killian-Jamieson diverticulum (KJD) is an unfamiliar and rare cervical esophageal diverticulum. This diverticulum originates on the anterolateral wall of the proximal cervical esophagus through a muscular gap (the Killian-Jamieson space) below the cricopharyngeal muscle and lateral to the longitudinal muscle of the esophagus. To date, only surgical treatment has been recommended for a symptomatic KJD due to its close proximity to the recurrent laryngeal nerve and the concern of possible nerve injury. Recently, traditional open surgery for a symptomatic KJD is being challenged by the development of new endoscopic techniques and devices. We present here a case of a symptomatic KJD that was successfully treated with the flexible endoscopic diverticulotomy using two new devices. An isolated-tip needle-knife papillotome (Iso-Tome) was used for the dissection of the tissue bridge of the diverticulum. And a flexible overtube with a modified distal end (a fitted overtube) was used for adequate visualization of the tissue bridge of the diverticulum and protection of the surrounding tissue during dissection of the tissue bridge. Our successful experience suggests that the flexible endoscopic diverticulotomy with the use of appropriate endoscopic devices can be a safe and effective method for the treatment of a symptomatic KJD.
Lee
Chang-Kyun
CK
Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan Hospital, 23-20 Bongmyung-dong, Cheonan, Choongnam 330-721, South Korea.
Chung
Il-Kwun
IK
Park
Ji-Young
JY
Lee
Tae-Hoon
TH
Lee
Suck-Ho
SH
Park
Sang-Heum
SH
Kim
Hong-Soo
HS
Kim
Sun-Joo
SJ
D004238:Diverticulitis / Q000473:pathology / Q000601:surgery*; D004936:Diverticulum, Esophageal / Q000473:pathology / Q000601:surgery*; D004867:Equipment Design; D016629:Esophagectomy / Q000295:instrumentation / Q000379:methods*; D020701:Esophagoscopes; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008875:Middle Aged; D013525:Surgical Instruments; D016896:Treatment Outcome