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Endoscopic stapling of pharyngeal pouch

Guidance issued Guidance issued
 
IP Guidance Number: IPG22
 
Summary:

The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on endoscopic stapling of pharyngeal pouch.

Description:

This procedure is used to treat pharyngeal pouch. 

Pharyngeal pouch, which is also known as Zenker's diverticulum, occurs when the pharyneal lining herniates through the muscles of the pharyngeal wall. It occurs mainly in older people, with an estimated overall incidence of about 1 per 100,000 per year.

A pharyngeal pouch may cause difficulty in swallowing or cough, and sometimes causes respiratory problems because of aspiration of the pouch contents.

Endoscopic stapling of pharyngeal pouch involves stapling of the opening of the pharyngeal pouch through a specially designed endoscope, under general anaesthetic.

The standard treatment for pharyngeal pouches is open surgery to the neck. The most radical procedure, open diverticulectomy, involves complete removal of the pouch. For small pouches, there are less radical procedures involving cutting the muscle (the cricopharyngeus) around the neck of the pouch and sometimes inverting the pouch. People who have open neck surgery usually need to have nasogastric feeding for up to a week afterwards, and are at risk of serious complications such as mediastinitis.

Endoscopic techniques are less invasive. The standard endoscopic technique, known as Dohlman's procedure, involves diathermy or lasers to divide the wall between the pouch and the oesophagus.

Arrangements:

Normal

Topic Area:

Digestive system
Mouth and dental

Specialty:

Cardio-thoracic surgery
Otolaryngology

Specialist advice has
been sought from:

British Association of Otorhinolaryngologists

Society of Cardiothoracic Surgeons of Great Britain and Ireland

Association of Upper Gastrointestinal Surgeons

Date notified to NICE: 01 April 2002
Guidance Publication Date: 26 November 2003
Contact Details:
Project Manager
(for general enquiries or comments)
Ben Doak
Contact Address:

Interventional Procedures Programme
National Institute for Health and Clinical Excellence
MidCity Place
71 High Holborn
London
WC1V 6NA


Links:

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