Tubular Esophageal Duplication Research Articles

Reconstruction of Adult Tubular Esophageal Duplication with Supraclavicular Artery Island Flap: A Rare Case Presentation.

Adult esophageal duplication (ED) is a rare congenital anomaly that is rarely encountered in clinical practice. There have been only a few reported cases of adult tubular esophageal duplication. A patient presented with symptoms of odynophagia and dysphagia. Upon examination, gastroscopy and X-ray contrast imaging revealed the formation of a fistula in the upper esophagus that connected to a sinus tract running along the esophagus. After managing the initial infection, an open surgery was performed. The esophageal tubular duplication was removed and the defect was reconstructed using a supraclavicular artery island (SAI) flap. The post-operative recovery was uneventful and the patient's odynophagia and dysphagia were relieved. In conclusion, ED can be effectively diagnosed through esophagogram and gastroscopy. Surgical excision is currently the preferred treatment option, and the use of the SAI flap technique shows great promise in reconstructing the esophageal defect after surgery.

Endoscopic septum division of tubular esophageal duplication in two children and systematic review

Tubular esophageal duplication is a rare congenital malformation The surgical treatment of this lesion can be challenging. We aimed to present our experience in two cases with tubular esophageal duplication. Both cases were endoscopically treated by a dual knife. The first patient underwent a single, while the second patient required three sessions of endoscopic septum division using an electrosurgical knife. Both showed satisfactory clinical, radiological and endoscopic response to treatment. Moreover, a systematic literature review has been performed. To identify all available studies, a detailed search on tubular esophageal duplication was performed according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Tubular esophageal duplication was reported in 16 pediatric cases in 14 studies in the literature. Surgery was applied to 10 of these cases and endoscopic treatment was applied to two of them. In the follow-up, nine patients who underwent surgical treatment and two patients who underwent endoscopic treatment were uneventful. Tubular esophageal duplications can be successfully treated endoscopically. Endoscopic septum division is a minimally invasive procedure that allows full anatomical recovery and satisfactory therapeutic response.

Endoscopic management of a tubular esophageal duplication in a young adult.

Endoscopic management of a tubular esophageal duplication in a young adult.

Tubular esophageal duplication with cervicothoracic cyst in the second trimester fetus

A case of esophageal duplication accompanied with double outlet right ventricle in the second trimester fetus is presented. Ultrasound examination at 15–16 weeks of gestation was found cystic masses and continuity with each other in the neck and upper thorax. Pathological examination revealed tubular esophageal duplication with cervicothoracic cyst and confirmed prenatal diagnosis of double outlet right ventricle.

THORACOSCOPIC TREATMENT IN NEWBORN WITH EXTENDED TUBULAR ESOPHAGEAL DUPLICATION

We present a case of complete extended tubular esophageal duplication in a newborn without concomitant abnormal development. Esophageal duplication is diagnosed based on the clinical picture, direct laryngoscopy, esophagography and contrastenhanced computed tomography. The esophageal duplication was removed by thoracoscopy, isolation from the pharynx was performed via a separate dissection on the neck.

Endoscopic membranotomy of a tubular type esophageal duplication cyst performed on a 5 year old child

Abstract Duplications of the gastrointestinal tract are rare malformations with an incidence of one in 4500 [1] –12500 [2] . Esophageal duplication cysts represent about 10% of all foregut duplications and are classified as cystic or tubular type duplications [3]. The tubular type esophageal duplication cyst is a rare subgroup of the esophageal duplication cysts seen in only 5%–10% of all cases [4] . We report about a 5-year- old boy with such a tubular type esophageal duplication cyst presenting with dysphagia and malnutrition. To our knowledge this is the first report about an endoscopic resection of an intraluminal bridge using an insulated scissors- type knife SB knife (SUMITOMO BAKELITE CO., Tokyo, Japan). The postoperative course was uneventful and the patient could be discharged only one day after surgery. The follow-up endoscopy three month later revealed no evidence of residuals of the duplication or remarkable stricture. We conclude that the endoscopic resection of tubular type esophageal duplication cysts is a save and preferable therapeutic option also in children.

Communicating Tubular Esophageal Duplication Combined with Bronchoesophageal Fistula.

Esophageal duplication (ED) is rarely diagnosed in adults and is usually asymptomatic. Especially, ED that is connected to the esophagus through a tubular communication and combined with bronchoesophageal fistula (BEF) is extremely rare and has never been reported in the English literature. This condition is very difficult to diagnose. Although some combinations of several modalities, such as upper gastrointestinal endoscopy, esophagography, computed tomography, magnetic resonance imaging, and endoscopic ultrasonography, can be used for the diagnosis, the results might be inconclusive. Here, we report on a patient with communicating tubular ED that was incidentally diagnosed on the basis of endoscopy and esophagography during the postoperational evaluation of BEF.

Tubular Esophageal Duplication

Infected total tubular esophageal duplication was detected in an 11-year-old boy presenting with chest pain, dysphagia, cough, and fever. Esophagram (supplemental Fig. 1 [esophagram: water-soluble contrast medium showed a double esophageal lumen extending approximately 5 cm; arrowheads: double lumen, nonlinear arrow: septum, stars: communication between the 2 lumens, arrow: main lumen], https://links.lww.com/MPG/A161) and computed tomography (supplemental Fig. 2 [chest computed tomogram; minimum intensity projection on the sagittal plane confirmed a double esophageal lumen], https://links.lww.com/MPG/A162) revealed an esophageal pseudolumen. Endoscopy showed 2 esophageal lumens (Fig. 1). The main lumen was larger with normal mucosa, whereas the accessory lumen was narrower and lined with ulcerated tissue. The gastroscope was passed into the accessory lumen up to its distal communication with the main lumen. Surgery has been the unique treatment so far (1–3), except for a recently reported experience in operative endoscopy (4). An endoscopic treatment was therefore attempted. Using a standard videogastroscope, a guidewire was firstly placed in the accessory lumen, then a diathermic knife (ITDK, Lorenzatto, Turin, Italy), having an insulated ball in its tip to avoid potential injury beyond the cut zone (5), was inserted and connected to an intelligent electrosurgical workstation (ICC 200 E; ERBE, Marietta, GA). Starting from the upper end of the duplication and using the guidewire as reference for a straight incision, a lengthwise step-by-step mixed cutting and cautery of the intraluminal bridge were then performed (Fig. 2), with the ENDO-CUT mode set at 50/25 W, respectively. No complications were recorded. The child was discharged on day 3 after the procedure and is presently asymptomatic at 18-month follow-up. (supplemental Fig. 3 [endoscopy 3 months after the procedure; unique lumen with 2 longitudinal mucosal folds as scars of the previous incision of the intraluminal bridge], https://links.lww.com/MPG/A163).FIGURE 1: Upper endoscopy of the esophagus. 1: main lumen; 2: intraluminal bridge; 3:accessory lumen.FIGURE 2: Incision of the intraluminal bridge (2) using an ITDK (4). Superiorly the main lumen (1); inferiorly the accessory lumen (3).Esophageal duplications represent about 10% of all of the foregut duplications. The tubular type is extremely rare (5%–10% of cases) (1). They frequently appear before 2 years of age but can be incidentally discovered in adulthood (2,6). Most frequent symptoms are dysphagia, hemorrhage, chest pain, compression of adjacent organs, infection, perforation, and respiratory involvement. This observation confirms the possibility that total tubular esophageal duplication can be successfully managed by endoscopy avoiding surgery.

Complete endoscopic management of tubular esophageal duplication in a young woman

A 29-year-old woman was referred to our department for endoscopic dilation of upper esophageal stricture. Dilation was performed with Savary–Gilliard dilators allowing the passage with resistance of a standard flexible video gastroscope (EG-201FP; Fujinon, Willich, Germany). Esophagogastroduodenoscopy showed a double esophageal lumen at 18 cm from the incisors. A thick bridge of intact mucosa separated the two lumens ([Fig. 1]). The passage of the endoscope through the second lumen was not possible. At 32 cm, a distal defect was also found. A barium esophagogram and high-resolution computed tomography (CT) scan confirmed esophageal tubular duplication ([Fig. 2] and [Fig. 3]).

PP23 ENDOSCOPIC TREATMENT OF ESOPHAGEAL TUBULAR DUPLICATION IN A BOY

Objective: Esophageal duplications are very rare congenital malformations that can be diagnosed at any age. Patients remain asymptomatic unless complications occur. Surgery is the standard treatment. The experience of endoscopic treatment is very limited. We report a case of a boy with esophageal tubular duplication successfully treated with endoscopic resection. Case Report: A 10-year-old boy with an uneventful medical history was urgently admitted in a peripheral hospital for acute dysphagia and severe retrosternal pain. During admission sialorrhea, cough, and fever appeared. Physical examination and chest X-rays were normal. Antibiotics were started with fever and cough resolution, but persistence of severe dysphagia with weight loss of 7 kg. Endoscopy demonstrated two ulcerations in proximal and distal esophagus, with mucus and pus. After a chest CT scan an esophageal duplication was suspected. The patient was then referred to our Institute. Because our initial suspect was a dissecting intramural hematoma, the child was maintained fasted in parenteral nutrition and antibiotics were continued. Barium esophagram revealed a double-barrelled esophagus with a longitudinal septum between two lumens, suggesting intramural esophageal dissection or esophageal duplication. Upper endoscopy showed two orifices in the mid-esophagus. Endoscope (5.9 mm ∅, GIF-XP160, Olympus) advanced through the main lumen and then through the 5-cm-long pseudo-lumen that presented normal esophageal mucosa with partial ulcerations and a distal wide communication to the main one. A thick bridge separated the two lumens. The diagnosis of a complete tubular duplication was confirmed. A nasogastric tube was inserted in the main lumen under direct vision and enteral feeding was started. Therapeutic endoscopy under general anesthesia was finally performed, with paediatric surgeons in attendance in case of failure or complications. After the insertion of a guide wire in the pseudo-lumen an insulated tip diathermic knife (ITDK, M.G. Lorenzatto, Turin, Italy) was connected through the endoscope channel to an electrosurgical intelligent workstation (ICC 200 E, ERBE, GA, USA), setting the ENDO-CUT® mode at 50/25 W. Starting from the upper opening a step by step mixed cutting and cautery of the septum was done, obtaining a lengthwise resection. The endoscopic procedure was completed uneventfully with success. The patient started to drink in the same day and oral food intake was introduced the next day without problems. He was discharged within 72 hours. Repeated endoscopy after 4 months showed normal esophagus with 2 longitudinal residual folds, without stenosis. At 8 months follow-up he is asymptomatic and in excellent general condition with full weight recovery. Conclusions: The diagnosis of esophageal tubular duplication is often occasionally and not easy, especially during complications. Repeated upper endoscopy is sometimes necessary to clarify the etiology of esophageal wall abnormalities. The definitive treatment is surgical excision, although the endoscopic treatment has been recently suggested. To our knowledge, only one complete endoscopic management of a tubular esophageal duplication has been reported so far. We describe another case of successfully endoscopic resection without complications. We used an ITDK, a device particularly useful to avoid potential injury of esophageal wall during the cutting of the interluminal septum. Our experience adds information about operative endoscopy for these rare esophageal congenital defects. Expert endoscopist should consider this less-invasive method as a valid alternative to surgery. PP24

Communicating Tubular Duplication of Upper Esophagus–A Rare Occurrence

Duplications of esophagus are commonly classified into two types, tubular and cystic. Tubular duplication of esophagus is a rare occurrence and is much less common than cystic duplication of foregut. Most esophageal duplications are located in the lower third of the esophagus. A cervical esophageal duplication is extremely rare. Esophageal duplications have been reported twice as commonly on the right as on the left. We report a case of incidental finding identified on computed tomography of communicating tubular esophageal duplication involving the left side of the upper esophagus in a tuberculosis patient that was subsequently confirmed on barium swallow test.

Endoscopic management of a tubular esophageal duplication diagnosed in adolescence (with )

Esophageal duplication is a rare congenital lesion. Surgery is the standard treatment. Tubular duplication is extremely rare, with esophageal communication in very few cases. The aim of this study was to document the feasibility of the endoscopic management of tubular esophageal duplication. Case report. A 14-year-old boy presented with acute dysphagia and acute retrosternal pain. Based on his radiographic and endoscopic findings, a cystic esophageal duplication with an upper esophageal stricture was initially suspected. A laparoscopic gastrostomy was performed. A cyst resection through right thoracoscopy assisted by flexible endoscopy was decided upon. When no extraluminal cystic duplication was found, a tubular duplication was considered and the procedure was abandoned. An endoscopic treatment was performed. A standard endoscope was inserted through an upper esophageal stricture. Two lumens were identified 25 cm from the incisors. A pediatric endoscope was passed through the main one, revealing a thick intraluminal bridge. By using a guidewire, the endoscope's passage into the narrow lumen revealed a distal communication with the esophagus. With the guidewire left in place, the endoscope was reintroduced into the main lumen. A lengthwise incision of the bridge was performed by using a needle knife. At the end of the procedure, an esophageal dilation was performed. Histology confirmed the diagnosis of duplication. The endoscopic incision of the duplication was completed uneventfully. For 11 months, the patient followed a normal diet and experienced no symptoms. Single case. To our knowledge, this is the first report of successful endoscopic incision of a total tubular esophageal duplication.

Tubular Duplication of the Esophagus - A Rare Cause of Dysphagia in the Adult

Purpose: Duplication of the esophagus is a rare congenital malformation caused by an error in early embryogenesis. The Dutch anatomist Gerhard Blaes first described this anomaly in the eighteenth century. The incidence is about 1 in 8200. While the cystic form is more commonly observed the tubular type of esophageal duplication seems to be extremely rare - with about 5-10% of these cases. Most of the patients suffering from esophageal duplication (70-90%) become symptomatic in childhood and are diagnosed before 2 years of age. To our knowledge, only few case reports exist with tubular esophageal duplication, incidentally discovered in adulthood. Methods: A 48-year-old male Caucasian was referred to our department, suffering from progressive dysphagia since 2 years. The findings leading to the diagnosis: “tubular duplication of the esophagus” will be presented. Results: Upper GI endoscopy revealed a stenosis of unknown origin at 25 cm from the incisors, which could not be passed with a conventional endoscope (Ø 8.8 mm). The stenosis was marked by two lumina separated by a bridge of intact mucosal epithelium. Using a filling catheter, both lumina could be explored by fluoroscopy showing that both tubular structures eventually lead into the stomach. CT scans showed extensive thickening of the esophageal wall, probably due to scarring, with formation of a septum in the esophageal lumen. After dilation therapy, upper GI endoscopy was again performed with a pediatric endoscope (Ø 5.9 ). The stenosis at 25 cm from the incisors could be passed and a normal gastro-esophageal junction was seen at 42 cm. At 38 cm from the incisors, a septum of intact mucosa was found similar to that in the proximal esophagus. Again, two lumina could be observed, however, only the larger lumen could be intubated. A guide-wire, introduced at 25cm showed communication of the two esophageal ducts at 35cm. Miniprobe endosonography revealed normal layers of the esophageal wall as well as within the septum. Kinematography showed a long-segment stenosis of the upper esophagus and an additional filiform, blind-ending lumen ventral of the esophageal main lumen. Conclusion: With regard to the present literature, surgery is the first-line treatment of tubular esophageal duplication. Esophagectomy and gastric interposition should also prevent malignant transformation, which may occur. Following this extensive operation, numerous adjustments in daily life have to be managed by the patients. PPI therapy is thought to relieve symptoms of dysphagia. In our case, dilation therapy and PPI medication have led to slight clinical improvement with satisfactory relief of the patients complaints. At the time being, the patient refuses surgery.

Noncommunicating tubular duplication of the upper pouch in esophageal atresia without fistula

We report a unique combination of an esophageal atresia without fistula associated with a tubular noncommunicating esophageal duplication. The diagnosis was made at delayed repair and led to a successful outcome.

A 16-month-old boy vomits a double tongue: intraluminal duplication of the cervical esophagus in children

A 16-month-old boy presented with a story of stridor, solid dysphagia and a history of spectacular protrusion underneath his tongue which was mistaken by the parents for a snake's tongue! The radiological examinations showed a filling defect of the upper and middle third esophagus which compressed the cervical trachea. This was found to be an intraluminal tubular esophageal duplication. Treatment by cervicotomy and unusual histological facts are presented.

Unusual Bronchopulmonary Foregut Malformation Associated with Pericardial Defect: Bronchogenic Cyst Communicating with Tubular Esophageal Duplication

We report a case of unusual bronchopulmonary foregut malformation composed of a mediastinal bronchogenic cyst with sequestrated lung tissue and communicating tubular esophageal duplication associated with complete pericardial defect. A 18-yr-old man, who had suffered from dry cough and mild dyspnea, was admitted because of an incidentally detected chest mass. A computed tomography scan demonstrated a cystic mass with an air fluid level connected with esophagus in the middle mediastinum. The surgically resected mass was a pleural invested accessory lobe of the lung (8.0×7.0×4.5 cm) connected with the esophageal wall by a tubular structure (3.0 cm in length and 2.0 cm in diameter). A complete left pericardial defect was also identified. Histologically, the cystic wall was composed of fibrovascular connective tissue with a smooth muscle layer, mixed seromucous glands and cartilage, and the inner surface of the cyst was lined by ciliated pseudostratified columnar epithelium. The inner surface of the tubular structure was lined by non-keratinizing or keratinizing squamous epithelium, and the wall contained submucosal mucous glands, muscularis mucosa, and duplicated muscularis propria. This case is important in understanding the embryological pathogenesis of the variable spectrum of the bronchopulmonary foregut malformation.

Tubular esophageal duplication associated with esophageal stenosis, pericardial aplasia, diaphragmatic hernia, ramification anomaly of lower lobe bronchus, and partial pancreas annulare: J. Fuchs, S. Grasshoff, E. Schirg, et al. Eur J Pediatr Surg 8:102–104, (April), 1998

Tubular esophageal duplication associated with esophageal stenosis, pericardial aplasia, diaphragmatic hernia, ramification anomaly of lower lobe bronchus, and partial pancreas annulare: J. Fuchs, S. Grasshoff, E. Schirg, et al. Eur J Pediatr Surg 8:102–104, (April), 1998