Guidance
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.
Description
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.