Duodenal duplication cysts are rare, accounting for only 2% to 12% of digestive tract
duplications [1]. Symptoms typically include abdominal pain, nausea, gastrointestinal bleeding, or
pancreatitis [1]. Though generally benign, there is a potential for malignant transformation, making
early treatment essential [2]. Surgical management is the standard treatment, although endoscopic marsupialization
has been used. A recent study found that only 3 out of 28 patients (10.7%) with intraduodenal
cysts without pancreatic or bile duct invasion were treated endoscopically [3].
We present the case of an 18-year-old patient with intermittent abdominal pain since
the age of 2, without blood test abnormalities. Abdominal ultrasound and computed
tomography scan revealed a 43 × 27 × 27 mm cyst in the third portion of the duodenum
([Fig. 1]). Magnetic resonance imaging showed no stones or communication with the bile duct,
pancreas, or main pancreatic duct.
Fig. 1 Computed tomography scan of the duodenal duplication cyst. a Axial view. b Coronal view.
Given these findings, we opted for an endoscopic approach as the first-line treatment.
Preoperative endoscopic ultrasound suggested that the duodenal duplication might be
confined to the duodenal submucosa. During the procedure, we identified a prolapsing
mass within the duodenal lumen, covered with normal mucosa. Using an Olympus PCF 190
TI colonoscope (Olympus, Tokyo, Japan), we performed endoscopic mucosal resection
(EMR) to debulk the mass, revealing a pseudo-depressed central area covered with duodenal
mucosa. Submucosa was observed on the peripheral sections, prompting us to inject
it and proceed with endoscopic submucosal dissection (ESD) using the adaptative traction
device A-TRACT (ATRACT Device and Co., Lyon, France) ([Video 1]) [4]. This technique allowed for precise and controlled removal of the duplicated mucosa,
with no residual tissue considering the potential risk of degeneration.
Combined endoscopic mucosal resection and endoscopic submucosal dissection of a duodenal
duplication cyst with adaptative traction device.Video 1
The clinical outcome was favorable, with complete resolution of abdominal pain. No
immediate or 3-month complications such as bleeding, perforation, or stricture were
observed.
Endoscopic management with complete resection using EMR and ESD was effective and
safe. It could be a viable option in selected cases.
Endoscopy_UCTN_Code_TTT_1AO_2AG_3AD
E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy.
All papers include a high-quality video and are published with a Creative Commons
CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission
process. We grant 100% waivers to articles whose corresponding authors are based in
Group A countries and 50% waivers to those who are based in Group B countries as classified
by Research4Life (see: https://www.research4life.org/access/eligibility/).
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos.
