The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Flexible endoscopic treatment of a pharyngeal pouch, in February 2015.


A pharyngeal pouch, also known as Zenker's diverticulum, occurs when part of the pharyngeal lining herniates through the muscles of the pharyngeal wall. This occurs mainly in older people. Presenting symptoms include dysphagia, regurgitation of undigested food, halitosis, hoarseness, and chronic cough. It sometimes causes respiratory problems because of aspiration of the pouch contents into the lungs. As the pouch enlarges, symptoms become more severe and may result in weight loss and malnutrition. In a small proportion of patients, carcinoma may develop in the pouch.

The traditional treatment for pharyngeal pouch involves open surgery to the neck. Open diverticulectomy involves complete removal of the pouch. Alternatively, the muscle responsible for pouch formation may be divided (sometimes combined with inversion or invagination of the pouch). Endoscopic techniques using rigid endoscopes are also used, in which the wall between the pouch and the oesophagus is divided using diathermy, lasers or a stapling technique.

Coding recommendations

E24.3 Endoscopic operations on pharyngeal pouch

The NHS Classifications Service has advised NICE that currently these are the most suitable OPCS-4 codes to describe this procedure. The OPCS-4 classification is designed to categorise procedures for analysis and it is not always possible to identify a procedure uniquely.

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.

  • National Institute for Health and Care Excellence (NICE)