Killian Jamieson Diverticulum, the Great Mimicker: A Case Series and Contemporary Review

Rebecca Howell; Alice Tang; Jacqui Allen; Mekibib Altaye; Milan Amin; Semirra Bayan; Peter Belafsky; Brian Cervenka; Brad deSilva; Greg Dion; Dale Ekbom; Aaron Friedman; Mark Fritz; John Paul Giliberto; Elizabeth Guardiani; Jeffrey Harmon; Jan L Kasperbauer; Sid Khosla; Brandon Kim; Maggie Kuhn; Paul Kwak; Yue Ma; Lyndsay Madden; Laura Matrka; Ross Mayerhoff; Cyrus Piraka; Clark Rosen; Meredith E Tabangin; Shaun A Wahab; Keith Wilson; S Carter Wright; Vyvy Young; Sonia Yuen; Gregory N Postma

doi:10.1002/lary.30508

Killian Jamieson Diverticulum, the Great Mimicker: A Case Series and Contemporary Review

Laryngoscope. 2023 Sep;133(9):2110-2115. doi: 10.1002/lary.30508. Epub 2022 Dec 1.

Authors

Rebecca Howell¹, Alice Tang¹, Jacqui Allen², Mekibib Altaye³, Milan Amin⁴, Semirra Bayan⁵, Peter Belafsky⁶, Brian Cervenka¹, Brad deSilva⁷, Greg Dion¹, Dale Ekbom⁵, Aaron Friedman¹, Mark Fritz⁸, John Paul Giliberto⁹, Elizabeth Guardiani¹⁰, Jeffrey Harmon¹, Jan L Kasperbauer⁵, Sid Khosla¹, Brandon Kim⁷, Maggie Kuhn⁶, Paul Kwak⁴, Yue Ma¹¹, Lyndsay Madden¹⁰, Laura Matrka⁷, Ross Mayerhoff¹², Cyrus Piraka¹³, Clark Rosen¹¹, Meredith E Tabangin³, Shaun A Wahab¹⁴, Keith Wilson¹, S Carter Wright^{10

15}, Vyvy Young¹¹, Sonia Yuen¹, Gregory N Postma¹⁶

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA.
² Department of Surgery, University of Auckland, Auckland, New Zealand.
³ Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
⁴ Department of Otolaryngology-Head and Neck Surgery, New York University, New York, New York, USA.
⁵ Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.
⁶ Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Davis, California, USA.
⁷ Department of Otolaryngology-Head and Neck Surgery, Ohio State University, Columbus, Ohio, USA.
⁸ Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, USA.
⁹ Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA.
¹⁰ Department of Otolaryngology-Head and Neck Surgery, Wake Forest University, Winston-Salem, North Carolina, USA.
¹¹ Department of Otolaryngology-Head and Neck Surgery, University of California - San Francisco, San Francisco, California, USA.
¹² Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, USA.
¹³ Department of Gastroenterology/Hepatology, Henry Ford Health System, Detroit, Michigan, USA.
¹⁴ Department of Radiology, University of Cincinnati, Cincinnati, Ohio, USA.
¹⁵ Department of Otolaryngology-Head and Neck Surgery, University of Maryland, Baltimore, Maryland, USA.
¹⁶ Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia at Augusta University Health, Augusta, Georgia, USA.

PMID: 36453465
DOI: 10.1002/lary.30508

Abstract

Objective: To assess barium esophagram (BAS) as a diagnostic marker for patients with Killian Jamieson diverticula (KJD).

Methods: Prospective, multicenter cohort study of individuals enrolled in the Prospective OUtcomes of Cricopharyngeus Hypertonicity (POUCH) Collaborative. Patient demographics, comorbidities, radiographic imaging reports, laryngoscopy findings, patient-reported outcome measures (PROM), and operative reporting were abstracted from a REDCap database and summarized using means, medians, percentages, frequencies. Paired t-tests and Wilcoxon Signed Rank test were used to test pre- to post-operative differences in RSI, EAT-10, and VHI-10 scores. Diagnostic test evaluation including sensitivity, specificity, positive, and negative predictive value with 95% confidence intervals were calculated comparing BAS findings to operative report.

Results: A total of 287 persons were enrolled; 13 (4%) patients were identified with confirmed KJD on operative reports. 100% underwent open transcervical excision. BAS has a 46.2% (95% confidence interval [CI]: 23.2, 70.9) sensitivity and 97.8% (95% CI: 95.3, 99.0) specificity in detecting a KJD and 50% (95% CI: 25.4, 74.6) positive predictive value but 97.4% (95%CI: 94.8, 98.7) negative predictive value. Preoperatively, patients reported mean (SD) RSI and EAT-10 of 19.4 (9) and 8.3 (7.5) accordingly. Postoperatively, patients reported mean (SD) RSI and EAT-10 as 5.4 (6.2) and 2.3 (3.3). Both changes in RSI and EAT-10 were statistically significant (p = 0.008, p = 0.03).

Conclusion: KJD are rare and represent <5% of hypopharyngeal diverticula undergoing surgical intervention. Open transcervical surgery significantly improves symptoms of dysphagia. BAS has high specificity but low sensitivity in detecting KJD.

Level of evidence: 4 Laryngoscope, 133:2110-2115, 2023.

Keywords: CPMD; Killian Jamieson; Zenker diverticulum; cricopharyngeus bar; cricopharyngeus dysfunction; cricopharyngeus muscle dysfunction; hypopharyngeal diverticulum; pharyngoesophageal dysphagia.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Cohort Studies
Diverticulum*
Diverticulum, Esophageal* / diagnosis
Diverticulum, Esophageal* / surgery
Humans
Prospective Studies
Zenker Diverticulum* / diagnostic imaging
Zenker Diverticulum* / surgery