2 The procedure
2.1.1 Pharyngeal pouch, which is also known as Zenker's diverticulum, occurs when a piece of the pharyngeal 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 people per year.
2.1.2 Pharyngeal pouch may cause difficulty in swallowing or a cough, and sometimes causes respiratory problems because of aspiration of the pouch contents into the lungs.
2.1.3 The standard treatment for pharyngeal pouch is open surgery to the neck. Endoscopic techniques are less invasive than open surgery. The standard endoscopic technique, known as Dohlman's procedure, uses diathermy or lasers to divide the wall between the pouch and the oesophagus. Endoscopic stapling of pharyngeal pouch is an alternative to the standard endoscopic technique.
2.2.1 Endoscopic stapling of pharyngeal pouch involves stapling the bar of tissue that divides the pouch from the oesophagus. A specially designed endoscope is used to gain access to the bar and the openings of both the pouch and the oesophagus. The procedure is performed under general anaesthetic.
2.3.1 The evidence suggested that endoscopic stapling allows a more rapid recovery, and requires a shorter stay in hospital (1–2 days) than open surgery. Patients returned to normal swallowing promptly. For more details refer to the sources of evidence section.
2.3.2 The Specialist Advisors considered endoscopic stapling to be an established procedure, now widely practiced in specialist centres by specifically trained otorhinolaryngologists. They considered it effective in terms of reducing operating time and the duration of hospital stay.
2.3.3 The Specialist Advisors noted that the problem can recur but that the procedure can be repeated if this happens.
2.4.1 Few complications were reported in the studies reviewed. Mild bleeding, perforation of the pharynx and a need for nasogastric feeding were reported, but these were uncommon. For more details refer to the sources of evidence section.
2.4.2 The Specialist Advisors concurred that perforation and leakage from the pharynx were no more common with endoscopic stapling than with alternative procedures.
2.5.1 Training and post-operative care are of great importance. The 1996/97 'Annual Report of the National Confidential Enquiry into Peri-operative Deaths' recommended that sub-specialisation within otorhinolaryngology departments should occur for this procedure.