Shimamura Yuto, Fujiyoshi Mary Raina Angeli, Fujiyoshi Yusuke, Nishikawa Yohei, Ono Masashi, Owada Kaori, Ikeda Haruo, Onimaru Manabu, Inoue Haruhiro
Digestive Diseases Center Showa University Koto Toyosu Hospital Tokyo Japan.
DEN Open. 2021 Aug 24;2(1):e27. doi: 10.1002/deo2.27. eCollection 2022 Apr.
Killian-Jamieson diverticulum (KJD) is a rare type of esophageal diverticulum less commonly encountered compared with Zenker's diverticulum (ZD). Endoscopic approach for these diverticula has been rapidly evolving. Currently, a flexible endoscopic septum division is considered the first-line treatment for symptomatic ZD patients, however reported recurrence rates are over 10% according to recent literature. With the advent of submucosal tunneling technique established by per-oral endoscopic myotomy for achalasia, it has been applied to treat ZD named as Zenker's diverticulum per-oral endoscopic myotomy (Z-POEM) as a minimally invasive treatment. Although there are very few reports utilizing submucosal tunneling approach to KJD, we have opted to perform Z-POEM in order to safely perform complete dissection of the muscle septum while maintaining mucosal integration. Due to the difficulty of anatomical location of KJD, we created mucosal incision and subsequent submucosal tunnel directly at the level of the septum as opposed to creating a submucosal tunnel few centimeters proximal to the septum as being previously proposed. We report a case in which this technique was successfully performed with complete resolution of dysphagia without any adverse event. This technique permits to perform complete myotomies without the fear of causing perforation. Although larger cohorts are required to assess its safety and efficacy, Z-POEM to treat KJD seems to be promising.
基利安-贾米森憩室（KJD）是一种罕见的食管憩室，与Zenker憩室（ZD）相比较少见。针对这些憩室的内镜治疗方法一直在迅速发展。目前，对于有症状的ZD患者，柔性内镜隔膜切开术被认为是一线治疗方法，但根据最近的文献报道，复发率超过10%。随着经口内镜下肌切开术治疗贲门失弛缓症所建立的黏膜下隧道技术的出现，它已被应用于治疗ZD，即Zenker憩室经口内镜下肌切开术（Z-POEM），作为一种微创治疗方法。虽然利用黏膜下隧道方法治疗KJD的报道非常少，但我们选择进行Z-POEM，以便在保持黏膜完整性的同时安全地完成肌性隔膜的完全分离。由于KJD解剖位置的困难，我们直接在隔膜水平创建黏膜切口和随后的黏膜下隧道，而不是像之前所建议的那样在隔膜近端几厘米处创建黏膜下隧道。我们报告了一例成功实施该技术的病例，吞咽困难完全缓解，无任何不良事件。该技术允许进行完全的肌切开术而不必担心引起穿孔。尽管需要更大的队列来评估其安全性和有效性，但Z-POEM治疗KJD似乎很有前景。
