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 KuhnPaul 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

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)2110-2115
Number of pages6
JournalLaryngoscope
Volume133
Issue number9
DOIs
StatePublished - Sep 2023

Bibliographical note

Funding Information:
University of Wisconsin and University of Washington for supporting this work through their IRB process.

Publisher Copyright:
© 2022 The Authors. The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.

Keywords

  • CPMD
  • Killian Jamieson
  • Zenker diverticulum
  • cricopharyngeus bar
  • cricopharyngeus dysfunction
  • cricopharyngeus muscle dysfunction
  • hypopharyngeal diverticulum
  • pharyngoesophageal dysphagia

ASJC Scopus subject areas

  • Otorhinolaryngology

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