3 The procedure
3.1 Flexible endoscopic treatment of a pharyngeal pouch aims to divide the septum between the diverticulum and oesophagus, without the need for hyperextension of the neck that may be necessary when using a rigid endoscope. It can be done without general anaesthesia and may be particularly useful for older patients with significant comorbidity or spinal stiffness.
3.2 Flexible endoscopic treatment of a pharyngeal pouch is done with the patient under sedation or general anaesthesia. Initially, a diagnostic endoscopy is done, identifying the normal oesophageal lumen and allowing a nasogastric tube to be inserted. Under flexible endoscopic guidance, the septum (containing the cricopharyngeus muscle) is exposed and divided. The flexible endoscope can be used with a variety of different accessories (hood, cap, overtube) to aid the procedure. Division of the septum reconnects the pouch lumen with the normal pharyngo‑oesophageal pathway and also divides the part of the sphincter muscle implicated in pouch development. More than 1 treatment session may be needed to achieve adequate division of the septum and relief of symptoms.