Surgical interventions for pharyngeal pouch

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. The surgical management can be further divided into two broad categories: endoscopic and open procedures. In the first half of the twentieth 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.

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

We searched the Cochrane Ear, Nose and Throat Disorders Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library Issue 3, 2004, MEDLINE (1966 to 2004) and EMBASE (1974 to 2004). Reference lists of all identified trials and previous reviews were searched for additional trials. Further electronic searches for key authors identified were made. There were no language restrictions. The date of the last search was September 2004.

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

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

No trials were identified which fulfilled the criteria.

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.