Modayil Rani J, Zhang Xiaocen, Ali Mohammad, Das Kanak, Gurram Krishna, Stavropoulos Stavros N
Department of Gastroenterology, Hepatology, and Nutrition, NYU-Winthrop Hospital, Mineola, New York, United States.
Department of Medicine, Mount Sinai St Luke's-West Hospital Center, New York, New York, United States.
Endosc Int Open. 2022 Jan 14;10(1):E119-E126. doi: 10.1055/a-1548-5552. eCollection 2022 Jan.
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. 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). 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. Endoscopic tunneling diverticulotomy is a feasible, safe, and effective method to treat KJD.
基利安-贾米森憩室（KJD）是一种比Zenker憩室（ZD）更罕见且最近才被描述的下咽憩室。KJD比ZD更难处理，因为它往往向下延伸至纵隔上部，且憩室颈部紧邻喉返神经。关于KJD治疗的文献有限，经颈手术憩室切除术是主要的治疗方法。在此，我们描述两种内镜下憩室切开术治疗KJD的方法——直接憩室切开术和隧道式憩室切开术（下咽隧道或超短隧道——后者是我们的首选技术）。这是一项回顾性研究，纳入了2015年3月至2018年4月期间连续的13例患者。3例患者接受了直接憩室切开术，10例接受了隧道式憩室切开术（7例采用下咽隧道，3例采用超短隧道）。所有手术均在16至52分钟内完成。无出血、纵隔炎或喉返神经损伤迹象发生。在9至79个月（中位时间33个月）的随访中，临床成功率为92%（12/13）；11例患者症状完全缓解（术后症状评分为0），1例患者症状近乎完全缓解（偶尔残留吞咽困难）。1例接受直接肌切开术的患者症状缓解有限（频繁残留吞咽困难和偶尔残留反流），可能与肌切开不完全有关。内镜下隧道式憩室切开术是治疗KJD的一种可行、安全且有效的方法。
