Post written by Sauid Ishaq, FRCP, from Birmingham City University, Birmingham, United Kingdom.

We present this video case report of a 94-year-old woman referred with oropharyngeal dysphagia and previously failed intubation. Barium swallow had revealed Zenker’s diverticulum (ZD) and cricopharyngeal hypertrophy (CPH).

Conventional intubation was unsuccessful despite multiple attempts.  Eventually, a transparent cap was attached to tip of the gastroscope, which enabled the cricopharyngeus (CP) muscle to be pushed downward to open up the UOS. This then allowed passage of a nasojejunal tube (NJT) [NJFT-8- Cook Medical 8Fr] via the accessory channel. The gastroscope was intubated successfully over the NJT.

Cap-assisted intubation should be considered as it not only gives operating space but help to Cricopharyngeus muscle to allow access for opening of upper esophageal sphincter. Nase-endoscope (slim scope 6mm diameter) can also be of great help in difficult intubation.

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