Endoscopic diverticulotomy with an isolated-tip needle-knife papillotome (Iso-Tome) and a fitted overtube for the treatment of a Killian-Jamieson diverticulum

Figure 1 Barium swallow and endoscopic images. A: An antero-posterior view of a barium swallow image, showing a diverticular sac filled with contrast and food debris in the left lateral side of the cervical esophagus; B: An endoscopic view of the KJD that originates on the anterolateral wall of the cervical esophagus, which was filled with impacted food debris (black arrow: the tissue bridge; white arrow: The esophageal lumen).

Figure 2 A fitted overtube. A: A photograph of a fitted overtube. The distal end of a standard overtube is snipped off with a scissor in a rectangular form according to the size of the diverticular opening (arrow); B: An endoscopic view following insertion of a fitted overtube (white arrow: Tissue bridge; Black arrow: Overtube). The tissue bridge of the diverticulum is exposed in the fixed operational field. The surrounding esophageal wall is completely protected and stabilized.

Figure 3 Isolated-tip needle-knife papillotome. A: A photograph of an isolated-tip needle-knife papillotome (Iso-tome). Note the semi-oval shaped, isolated-tip composed of epoxide adhesive. B: An endoscopic view during the diverticulotomy. The Iso-Tome is inserted into the diverticular sac before dissection.

Figure 4 An endoscopic view at three months after the diverticulotomy. A wide communication between the diverticular sac and the esophageal lumen without a significant tissue bridge or retained food debris is shown.