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.


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.

Coding and clinical classification codes for this guidance

Guidance development process

How we develop NICE interventional procedures guidance

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. 

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.