S366 Endoscopic Marsupialization of a Large Duodenal Duplication Cyst

Abstract

Introduction: Duodenal duplication cysts are rare congenital malformations of the gastrointestinal tract. These malformations are usually diagnosed in infancy and childhood. Only one-third of adults are diagnosed after twenty years of age. Presenting symptoms and signs include abdominal pain and intestinal obstruction. These are generally found in the first and second parts of the duodenum. Although the majority are benign, case reports have demonstrated a risk of malignancy. The ideal treatment is complete surgical resection. Due to the proximity of structures including the biliopancreatic ducts, excision of the duodenal duplication cyst may require total pancreaticoduodenectomy. Advances in therapeutic endoscopy provide an alternative option for patients who are at a high risk of surgical complications. Endoscopic marsupialization is a management option in which the cyst cavity contents are drained into the duodenum. Complications include duodenal perforation and bleeding. However, the overall morbidity is low. Endoscopic surveillance is recommended in these patients to assess for recurrence. Case Description/Methods: We present a case of a 38-year-old female who was diagnosed with a large duodenal mass in the second part of the duodenum measuring 8 cm in the largest diameter. This was found incidentally during an upper endoscopy which was performed in July 2020 for hematemesis. The duodenal mass was cystic in appearance on cross-sectional imaging. She was offered endoscopic marsupialization in October 2020 due to morbid obesity which increased the risk of perioperative complications. Discussion: The procedure was performed successfully. Pathology from the lateral wall of the duodenal cyst was consistent with a duodenal duplication cyst. There were no early or delayed complications. The patient had a follow-up endoscopy one year later which did not demonstrate evidence of recurrence on biopsies. Watch the video at https://tinyurl.com/ACGAbstractS366