Surgical interventions for pharyngeal pouch

A pharyngeal pouch is a pocket which can develop in the pharynx (throat), just above the entrance to the oesophagus (gullet). It may cause difficulty in swallowing, sensation of a lump in the throat and troublesome regurgitation of food. Food may become lodged in the pouch and this, as well as regurgitation, may lead to weight loss, hoarseness of voice and recurrent chest infections. A pharyngeal pouch is treated by surgery which may either be 'open' (through an incision in the neck) or 'endoscopic' (through the mouth). The review found no evidence to show which surgical method is more effective.

Authors' conclusions: 

There is no evidence from high-quality randomised controlled trials to demonstrate the effectiveness of endoscopic compared with open procedures for pharyngeal pouch. There is no good evidence to establish whether one endoscopic procedure is superior to another.

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Background: 

This is an update of a Cochrane Review first published in The Cochrane Library in Issue 3, 2005 and previously updated in 2009.

A pharyngeal pouch is an out-pouching or pocket that develops from the posterior wall of the pharynx just above the entrance to the oesophagus (gullet). Pouches may give rise to difficulty in swallowing, sensation of a lump in the throat or of food sticking in the throat and may lead to troublesome regurgitation of food. Food may enter the pouch rather than passing down the oesophagus and this and regurgitation may result in weight loss, hoarseness of voice and/or recurrent chest infections. The management of patients with a pharyngeal pouch may be either conservative or surgical. Surgical management can be further divided into two broad categories: endoscopic and open procedures. In the first half of the 20th century an open surgical approach to the pouch was most frequently used and remains common in some parts of the world. In recent decades endoscopic procedures (where the approach is made through the mouth) have become popular. The superiority of one approach over another has yet to be clearly demonstrated.

Objectives: 

To assess the effectiveness and safety of open and endoscopic surgical procedures for the management of a pharyngeal pouch.

Search strategy: 

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the last search was 20 April 2011.

Selection criteria: 

We sought to identify all randomised controlled trials (RCTs) comparing two or more interventions.

Data collection and analysis: 

Three authors assessed the eligibility of trials for inclusion in the review, based on pre-determined criteria.

Main results: 

No trials were identified which fulfilled the criteria.

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