Presentation and Management of Killian Jamieson Diverticulum: A Comprehensive Literature Review

Abstract

Objective: To examine the clinical presentation, diagnostic evaluation, and management of Killian–Jamieson diverticula (KJD) through literature review. Methods: A comprehensive literature review was conducted through December 2018 using keywords Killian–Jamieson diverticula/diverticulum. Data extracted included clinical presentation, imaging characteristics, surgical management, and postoperative care. Sources: PubMed and Google Scholar. Results: Sixty-eight cases of KJD in 59 reports (29M:39F; median 58 years old) were identified for review. The most common presentation was dysphagia (n = 39), suspected thyroid nodule (n = 24) and globus (n = 14). The majority of KJD (n = 51) occur on the left, with rare reports of right side (n = 11) and bilateral (n = 5) presentation. Thirty-two cases describe surgical management: 22 utilizing a transcervical approach, with (n = 13) or without (n = 9) cricopharyngeal myotomy; and 10 reported endoscopic surgery. Diverticula managed transcervically averaged 3.8 cm in size in comparison to average 2.8 cm in the endoscopic group. Time to diet initiation after transcervical surgery averaged 4 days versus 2 days after endoscopic surgery. Complications were reported in 2/68 cases; both were diverticula recurrence after endoscopic surgery. Conclusion: Killian–Jamieson diverticula is a rare diagnosis that should be considered in the evaluation of dysphagia, globus, and also suspected thyroid nodule. When patient symptoms warrant intervention, a transcervical approach, with or without cricopharyngeal myotomy, is most commonly utilized. In recent years, an endoscopic approach has been presented as an alternative for smaller diverticula. Further understanding of the optimal treatment and postoperative management for KJD requires larger cohorts. Level of Evidence: 4

Killian Jamieson Diverticulum: A Rare Cause of Dysphagia

“…Other symptoms include regurgitation, globus sensation, cough, neck pain, neck swelling, hoarseness, and halitosis. On average, larger diverticula are associated with symptoms, with a median size of 2.5 cm [3]. Our patient had a 2.5 cm diverticulum, hence, the multiple symptoms.…”

“…The mean age at diagnosis is 58 with female predominance, which fits our patient's profile. Most cases are unilateral and reported on the left, perhaps suggesting a thinner muscle layer on that side [3]. Nevertheless, bilateral cases have been described in up to 25% of cases [4,5].…”

“…Killian-Jamieson diverticulum is usually asymptomatic and is often diagnosed incidentally on radiologic imaging. In symptomatic patients, dysphagia is the most common symptom [3]. Other symptoms include regurgitation, globus sensation, cough, neck pain, neck swelling, hoarseness, and halitosis.…”

“…Our patient had a 2.5 cm diverticulum, hence, the multiple symptoms. Interestingly, there is literature reporting a proportion of patients that were diagnosed with Killian-Jamieson diverticulum during thyroid nodule workup, which emphasizes the variety of presenting symptoms [3].…”

“…Another theory suggests that symptomatic KJD occurs as a result of esophageal dysmotility secondary to food debris [3].…”