Successful endoscopic treatment of an esophageal duplication cyst

Abstract

Duplication cysts of the gastrointestinal tract are rare, particularly in adults. Endoscopic minimally invasive treatment is still a challenging approach even in the endoscopically accessible sections of the gastrointestinal tract. In a 25-year-old patient suffering from dysphagia, an endoscopy and subsequent endosonography revealed a spherical duplication cyst in the lower third of the esophagus, which prompted us to puncture the cyst and subsequently to perform a fenestration (marsupialization; diameter 1 cm) in the anterior wall of the cyst, resulting in permanent drainage of the cystic fluid. Because of the recurrent complaints of the patient after 6 weeks, the anterior wall of the duplication cyst, the former esophageal wall, was partially resected, resulting in a permanent 4-cm opening including the cystic cavity into the esophageal lumen. Thereafter, there were no further complaints from the patient and the findings in the follow-up endoscopy were normal. A successful endoscopic intervention for this type of gastrointestinal duplication cyst is described for the first time. The minimally invasive resection of the anterior wall of the esophageal duplication cyst, simultaneously with the former regular wall at this segment of the esophagus, resulted in permanent inclusion of the cystic cavity into the esophageal lumen with no disadvantageous passage of fluid and food through the lower esophagus or changes in the former cystic epithelium. This method is considered to be feasible and a reasonable treatment alternative to the more invasive surgical approach.

Oesophageal duplication cysts, a rare cause of neck lump treated by ultrasound guided drainage: case report and review of the literature

“…If an air-fluid level is present, this suggests a communicating cyst [17]. However, endoscopic ultrasound has also been used in delineating these lesions with some success when visualising a thin walled, cystic, hypoechoic mass and has an unknown role in the diagnosis of oesophageal duplication cysts in the future [18][19][20] and there have also been documented success in endoscopic resection of oesophageal duplication cysts [21] and aspiration. In a 22-year-old man with a history of recurrent dyspepsia and dysphagia, an oesophageal duplication cyst was found at the lower oesophagus which was amenable to endoscopic aspiration guided by endoscopic ultrasound, which was performed with success [22].…”

Mediastinal Mass in a Patient with Colorectal Cancer: A Diagnostic Challenge

“…Some reports of endoscopic management of duplication cysts are available. Endoscopic fenestration of noncommunicating cyst has been successfully done and a step-by-step incision of the septum between the esophageal lumen and the communicating DEC has also been reported [10] . Treatment of asymptomatic DEC is controversial with no clear guidelines.…”

Subepithelial Lesions

“…The treatment of symptomatic or enlarging cysts has traditionally been surgical resection or marsupialization. Endoscopic treatments that have been described in case reports include snare resection, endoscopic incision, and marsupialization [113][114][115][116].…”