Esophageal Duplication Cyst, Successfully Treated Endoscopically: Case Report: Presidential Poster

Abstract

Purpose: Esophageal duplication cysts are unusual congenital anomalies of the foregut. It can present with symptoms of chest pain, dysphagia, or dyspnea. Diagnosis is made with combined imaging modalities such as CT scan, and/or Endoscopic Ultrasound (EUS). Currently the standard of care includes surgical resection. As of today, less invasive procedures are on the verge of investigation. This is the case report of a 41 year-old male with a chief complaint of retrosternal chest pressure occurring after meals, and dysphagia to solid food. The patient was diagnosed with an esophageal intraluminal mass on CT scan. Upper endoscopy revealed an esophageal intraluminal bulge that was nearly obstructing the esophageal lumen starting at 30 cm from the incisor extending to 38 cm from the incisor. The EUS revealed an anechoic lesion originated from the muscularis propia layer consistent with duplication cyst. Giving that the patient was symptomatic, endoscopic cyst marsupialization was planned to achieve minimally invasive treatment compared to surgical resection. The anterior wall of the cyst was punctured using a 19-gauge needle (Cook, Winston Salem, NC). A 450 cm long 0.035 mm Guidewire (Boston Scientific Corp., Natick, MA, USA) was inserted through the 19-gauge needle followed by exchange of the EUS needle for a needle knife (Boston Scientific Corp., Natick, MA, USA) over the guidewire. 1 cm fenestration (marsupialization) was done in the anterior wall followed by insertion of the adult endoscope inside the cyst cavity for interrogation of the cyst wall. A successful longitudinal cut of the anterior cyst wall was done by needle knife and pallitome. The mucosa, submucosa and muscularis propia layer were cut achieving continuous communication between the cyst and esophageal lumen creating pseudodiverticulum. The procedure was done without complications. Follow-up with an upper endoscopy 2 months later showed cyst resolution. The patient had no further complaints of dysphagia or chest pain. Very few cases are reported in the current literature describing endoscopical resection of esophageal cyst. Endoscopic marsupialization of duplication cyst is a minimally invasive procedure, feasible, and a reasonable alternative to an open and invasive surgical approach.Figure: No Caption available.