LAUSR

A 68-year-old man presented with progressive dysphagia to solids and liquids, regurgitation of undigested food, and weight loss for the past three years. Upper gastrointestinal endoscopy followed by a barium esophagram revealed two contralateral diverticula in the cervical esophagus just below the cricopharyngeus. They measured 2 cm and 4 cm and were filled with food debris, consistent with two synchronous Killian-Jamieson diverticula (▶Fig. 1). After multidisciplinary evaluation, endoscopic treatment was proposed. The procedure was performed under general anesthesia with endotracheal intubation. A submucosal bleb was created proximal to the diverticula in the posterior wall, followed by a 1.5-cm mucosal incision (▶Video 1). A submucosal tunnel was created, which was then extended to both the end of the larger diverticulum and the proximal esophagus (▶Fig. 2). Tunneling was continued until the bottom of the diverticulum was reached. The septum was thus entirely exposed and a complete septotomy was performed (▶Fig. 3, ▶Fig. 4). Finally, the mucosal incision was closed using six clips. The procedure took 60 minutes and there were no complications. The patient progressed well and a postprocedural barium esophagram confirmed the absence of any extraluminal oral contrast leak. At 4 months after the procedure, the patient remains asymptomatic on a regular diet. A Killian-Jamieson diverticulum is an unusual form of esophageal diverticulum arising from a muscular gap in the anterolateral wall of the proximal cervical esophagus [1]. It can present with symptoms similar to those of a Zenker’s diverticulum and presents anatomic challenges for any intervention, particularly owing to the high risk of injury to the recurrent laryngeal nerve [1]. Because of its rare incidence, treatment remains controversial [1]. Endoscopic therapies E-Videos