Difficult intubation of a Zenker’s diverticulum with an acute angle

Ishaq_headshotPost 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.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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