Advanced endoscopic techniques for esophageal duplication cyst treatment: beyond surgery.

Background and Aims: Esophageal duplication cysts are rare congenital anomalies characterized by an epithelial lining and muscular wall. Nowadays, esophageal duplication cysts are increasingly detected because of increased use of gastroscopy and cross-sectional imaging. Although surgery remains the standard treatment, endotherapy has emerged as a viable minimally invasive alternative, particularly for symptomatic patients or those unwilling or unfit for surgery. Endoscopic approaches include resection, fenestration, decompression, and submucosal tunneling endoscopic resection (STER). Methods: This case series reviews 3 patients with symptomatic esophageal duplication cysts managed using advanced endoscopic techniques. Diagnosis was confirmed using gastroscopy and EUS. EUS demonstrated cystic lesions of submucosal origin with characteristic posterior acoustic enhancement. Endoscopic techniques included STER, and hybrid techniques combining EUS with endoscopic fenestration. All procedures were performed with the patient under sedation or general anesthesia, with postprocedure monitoring and follow-up at 1, 6, and 12 months. Results: Three endoscopic techniques of esophageal duplication cysts are described with successful results. STER was performed in 1 patient for a small symptomatic midesophageal cyst. Hybrid technique combining EUS and endoscopic fenestration was performed in 2 patients by 2 techniques: (1) guidewire as guiding structure and (2) plastic stent as guiding structure. All 3 patients remained asymptomatic at a median follow-up of 12 months. Conclusions: Advanced endotherapy, including hybrid techniques, offers an effective, minimally invasive alternative to surgery for managing esophageal duplication cysts. These procedures enable precise fenestration and reduce adverse events. Hybrid procedures can be considered for large cysts with exophytic components in patients at a high risk for surgery. Further studies with larger sample sizes and long-term follow-up are needed to validate these promising outcomes.