Post written by Ali Zakaria, MD, from the Division of Gastroenterology, Ascension Providence Hospital, Southfield, Michigan.

We present a case of an 82-year-old female patient with progressively worsening dysphagia to solid food, regurgitation, globus sensation, and halitosis. Barium esophagram revealed a 40-mm anterolateral protrusion at the level of the proximal cervical esophagus, consistent with KJD. Because of her age and significant comorbidities (hypertension, peripheral vascular disease, and cardiac arrhythmia requiring permanent pacemaker), she preferred to proceed with the least-invasive intervention. She underwent endoscopic treatment using the submucosal tunneling diverticulotomy technique. She tolerated the procedure well with no immediate or delayed procedural adverse events. She was admitted overnight for observation, and follow-up gastrografin esophagram revealed no evidence of extraluminal leak. She had no residual symptoms during her postprocedural clinic follow-up.

KJD is a rare type of esophageal diverticulum. It is usually asymptomatic and found incidentally on radiologic imaging for other purposes. Dysphagia is the most presenting symptom. The treatment of KJD is more challenging compared to Zenker’s diverticulum due to the close proximity of the diverticulum neck to the recurrent laryngeal nerve. Transcervical surgical myotomy is the mainstay approach for treatment; however, endoscopic therapies including direct septotomy or tunneling diverticulotomy have been reported as safe and effective. We described in this case tunneling diverticulotomy as it is preferred over direct diverticulotomy for its safety, with secure closure and lower risk of leak, and its effectiveness because it allows for longer myotomy and a lower recurrence rate.

The advancement in therapeutic endoscopic techniques can now offer patients with KJD a safe and effective treatment option, especially in patients with high risk for surgical intervention. Treating gastroenterologists should consider referring patients with KJD to centers with experience in third-space endoscopy.

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