Endoscopic Treatment Of Zenker’s Diverticulectomy (Pharyngeal Pouch)

Patient Information Leaflet

What is Zenker’s diverticulum?

Zenker’s diverticulum (also called a pharyngeal pouch) is a rare, benign condition that can significantly affect quality of life. It causes difficulty swallowing (dysphagia), coughing episodes, regurgitation of food, and sometimes chest infections.
In this condition, a pouch (sac) develops in the upper part of the oesophagus (gullet). This occurs due to dysfunction and spasm of the cricopharyngeal muscle, which sits at the entrance to the oesophagus. The condition is more common in older patients.

Endoscopic (Flexible) Treatment for Zenker’s Diverticulum

Over the last decade, Zenker’s diverticulum has been successfully treated using a flexible endoscope (gastroscope).

How the Procedure is Performed

• A flexible telescope is passed over the tongue and down the throat.
• The pharyngeal pouch is identified.
• The muscle bridge between the oesophagus and the pouch is carefully divided using a specialised endoscopic knife.
• A small metal clip is placed at the base of the cut to reduce the risk of perforation (a hole in the lining).

Benefits of the Flexible Technique

• Effective in over 85% of cases
• Shorter hospital stay
• Less discomfort after the procedure
• Most patients resume oral intake after 24 hours
• High overall success and patient satisfaction

Preparation for the Procedure

The procedure is performed under:

• General anaesthesia or
• Deep sedation using Propofol

Before the procedure 

•You must be nil by mouth for at least 12 hours beforehand.
•You will also remain nil by mouth for 24 hours after the procedure.
•Most patients go home the same day.
•Some patients stay overnight for observation.

A single dose of antibiotics may be given in selected patients.

Important information – this information must be relayed to Prof Ishaq team as well as pre-assessment team

Diabetes

If you are treated with insulin or tablets for diabetes, specialist advice is required. Please inform the pre-assessment team (patient Type 1 diabetes likely to stay overnight)

Blood Thinning Medication

If you take

•Clopidogrel
•Aspirin
•Rivaroxaban
•Edoxaban
•Warfarin

Please inform the pre-assessment team.

Typical guidance:

•Clopidogrel: stopped 7 days before the procedure.
•Rivaroxaban / Edoxaban: stopped 3 days before.
•Warfarin: individual advice depending on indication.

Risk of Endoscopic Zenker’s Diverticulectomy 

This procedure is considered safe, even in large case series.

Possible Complications

1. Perforation (Most Serious Risk)

•A hole may occur at the site of muscle division.
•If identified during the procedure, it is sealed with a clip.
•In large series (500+ patients), up to 5% had minor air leakage through the oesophageal wall.
•If this occurs, you may need:
oHospital stay.
oNil by mouth
oFeeding via nasal tube or intravenous drip
oAntibiotics

2. Bleeding

•Risk: 2–3%
•Usually controlled during the procedure with clips.

Video Recording
As a specialist centre in the UK, this procedure may be recorded for:
•Clinical presentations
•Teaching
•Publication
No identifiable patient information is used. You will be asked for consent on the day of the procedure.

After the Procedure

You may experience:
•Mild neck pain
•Throat irritation
You will remain nothing by mouth for 24 hours and receive intravenous fluids.

Diet After 24 Hours

If well and no complications:
•Ice cream or yogurt.
•Soft diet for 2–3 days
•Gradual return to normal diet

Important:
•Chew food well.
•Take small mouthfuls.

Advice regarding diabetes or blood thinning medication will be given individually.

Seek Urgent Medical Attention If You Experience:
•Severe neck pain
•Severe pain when swallowing
•Breathlessness
•Chest pain
•Vomiting blood
•Black stools
•Neck pain or shortness of breath when eating or drinking

Going Home

You may:
•Go home the same day if stable.
•Stay 24 hours if observation is required.

Aftercare Advice (first 24-48 hours)

1. Mild sore throat or hoarseness may occur. Liquid paracetamol after 24 hours for throat pain.
2.Do not smoke or drink alcohol for 24 hours.
3.Do not drive or operate machinery for 24 hours.
4.Do not sign legal documents for 24 hours.
5.Avoid heavy lifting for 48 hours.
6.Pain when swallowing can usually be treated with paracetamol or ibuprofen syrup.
7.Monitor for fever, dizziness, bleeding, swelling, redness, or feeling unwell.

Follow Up

A follow up appointment will be arranged via telephone with Prof Ishaq team.

Contact information

Endoscopy unit – Prof Ishaq team01384 456111 Ext. 2731
8am – 6:30pm (out of hours A&E)
More information here: National Centre of Flexible Endoscopic Treatment of Zenker Diverticulum (Pharyngeal pouch) – The Dudley Group NHS Foundation Trust