A 34-year-old woman was referred to our hospital because of the development of dysphagia
and weight loss. Esophagogastroduodenoscopy (EGD) showed a submucosal tumor in the
middle of the esophagus ([Fig. 1 a]) and endoscopic ultrasonography (EUS) revealed a bilobed cystic lesion within the
submucosal layer. Computed tomography (CT) of the chest showed a well-defined, bilobed,
cystic mass in the mediastinum.
Fig. 1 Esophagogastroduodenoscopy images showing: a a submucosal tumor in the middle of the esophagus; b brownish liquid contents flowing out of the cyst after the initial incision; c the cyst following fenestration with an insulation-tip knife; d no evidence of recurrence 2 months after the procedure.
We performed endoscopic fenestration of the cyst. After we had made an initial incision
with a needle knife (Olympus, Tokyo, Japan), brownish liquid contents flowed out of
the cyst ([Fig. 1 b]). The cyst was fenestrated with an insulation-tip knife (Olympus) ([Fig. 1 c]; [Video 1]). The patient’s symptoms completely disappeared and there was no evidence of recurrence
on repeat EGD 2 months after the procedure ([Fig. 1 d]).
Video 1: Esophagogastroduodenoscopy showing a submucosal tumor in the middle of the
esophagus, from which brownish liquid contents flowed after an initial incision had
been made with a needle knife. The cyst was then fenestrated with an insulation-tip
knife.
Duplication cysts of the esophagus are rare congenital anomalies that arise from an
error in early embryonic development [1]. Duplication cysts are usually asymptomatic and, in most cases, are detected incidentally
on a routine EGD. Abu-Zaid et al. previously reported a patient with an esophageal
duplication cyst, which was treated by surgical excision [2]; however, treatment for this condition is currently moving from thoracotomy to endoscopic
treatments [1]. Endoscopic treatments are considered when EUS demonstrates that cysts are localized
within the submucosal layer and do not communicate with the deep muscular layer. Small
esophageal duplication cysts can be completely resected with a standard polypectomy
snare [3]. For larger cysts, careful fenestration with an insulation-tip knife is safe and
effective [4].
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