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.


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