Endoscopic ultrasound features of esophageal duplication cysts- a case series

Introduction: Esophageal duplication cysts (EDC) in adults are often asymptomatic and incidentally encountered. We evaluated 6 EDC cases at Institute of Liver and Biliary Sciences (ILBS), New Delhi, between January 2009 and January 2010, and describe the characteristic EUS features.

Methods: Imaging was done at 5 to 10MHz, using Olympus mechanical radial (GF- UM130), or curved linear (GF-UCT-AL5) probes. The esophagus wall was resolved into 5 layers by focal point adjustment and avoiding compression. The layer of origin was defined at the transition point of the lesion.

Results: The age ranged from 32 to 75 years (median: 43.5 years), and all were males. Four underwent endoscopy for dyspepsia, one for mild dysphagia, and one for variceal screening. In all patients, the lesion was discovered incidentally. CT scan diagnosed solid lesions in all 4 patients, in whom the lesion was visualized. EDC were defined by EUS as anechoic or hypoechoic lesions, in the submucosal layer or extrinsic to the wall. 3–5 sonographic wall layers (parts of mucosa, submucosa, muscularis propria, and adventitia) were external to the cyst. The internal contents were anechoic in 5, and hypoechoic in 1 case. One cyst contained layering debris. One lesion with hypoechoic internal contents was misdiagnosed as mesenchymal tumor (likely leiomyoma), and resected. Posterior acoustic enhancement and absence of perfusion signals on power Doppler were useful ancillary findings.

Conclusions: EUS is useful to diagnose EDC, by demonstration of layered wall structure. Cyst aspiration with its attendant infection risk, and surgical resection may be avoided by the use of EUS.