A 56-year-old man presented with progressive dysphagia for 12 months, but reported
no weight loss and no significant medical history. Gastroscopy revealed a bulge with
normal overlying mucosa in the lower esophagus ([Fig. 1]). Endoscopic ultrasound (EUS) showed a 5-cm hypoechoic intraluminal cystic mass
with clear margins originating from the muscularis propria ([Fig. 2]). A well-defined cystic mass without internal enhancement was observed on computed
tomography (CT) ([Fig. 3]).
Fig. 1 Endoscopic image showing a bulge in the lower esophageal wall with normal overlying
mucosa that was later shown to be an esophageal duplication cyst.
Fig. 2 Endoscopic ultrasound (EUS) view of the lesion showing a 5-cm hypoechoic cystic mass
with clear margins originating from the muscularis propria.
Fig. 3 Computed tomography (CT) scan image showing a cystic mass without internal enhancement
in the lower esophagus.
Endoscopic submucosal dissection (ESD) of the esophageal lesion was performed ([Video 1]). The lesion was raised by submucosal injection of 100 mL glycerol fructose (10 %)
mixed with 1 mL of indigo carmine. After an incision had been made on the cyst wall
with a dual-knife (KD-650L; Olympus, Tokyo, Japan), the yellowish fluid of the cyst
drained gradually and completely into the esophageal lumen. The lesion was completely
and uneventfully resected using the dual-knife and a hook-knife. Good visualization
of the cavity of the cystic lesion was subsequently obtained, and anhydrous alcohol
was sprayed into the cavity using a spray tube. There were no complications such as
bleeding or perforation.
Endoscopic submucosal dissection (ESD) of the esophageal lesion.
A diagnosis of an esophageal duplication cyst was made by histopathological examination
of the resected specimen. A repeat endoscopy was performed 7 days later, and anhydrous
alcohol was sprayed once again ([Fig. 4]). The patient reported a rapid recovery and denied dysphagia during a follow-up
period of 12 months.
Fig. 4 Appearance at follow-up endoscopy 7 days after endoscopic submucosal dissection (ESD)
of an esophageal duplication cyst and spraying of anhydrous alcohol.
Esophageal duplication cysts are rare congenital anomalies of the foregut and the
majority of patients are asymptomatic [1]. Surgical resection is generally required for cysts that cause symptoms such as
dysphagia, epigastric pain, and retrosternal pain [2]. Endoscopic treatment of esophageal duplication cysts has increased in recent years
because of its minimal invasiveness [3]
[4]. In this case, after performing ESD, we sprayed anhydrous alcohol, which is usually
used for treating liver or ovarian cysts. Because anhydrous alcohol can destroy the
epithelial cell layer of the cyst wall, the recurrence rate of cysts may, theoretically,
be lower. Further studies on the long-term efficacy and safety of this treatment are
required.
Endoscopy_UCTN_Code_TTT_1AO_2AD
