Optimising endoscopic stapling of pharyngeal pouches

Abstract

Background: Endoscopic hypopharyngeal diverticulotomy is now largely performed using an endoscopic stapling device. A poorly applied endoscopic stapling device can result in incomplete division of the cricopharyngeal bar, necessitating the application of a second set of staples. Applying more than one set of staples is associated with an increased risk of complications and greater cost. Small pharyngeal pouches are difficult to staple because of difficulties engaging the stapling device over the cricopharyngeal bar. Method: Two pairs of oesophageal forceps are used in conjunction with a 0 degree Hopkins rod to optimise the endoscopic stapling of small and large pharyngeal pouches. Results and conclusion: Applying grasping forceps to the cricopharyngeal bar improves the accuracy of the stapling procedure, thus reducing the morbidity and cost associated with multiple staple applications.