Post written by Theodore James, MD, from the University of North Carolina at Chapel Hill.

We describe a case of a woman with dysphagia, found to have an esophageal duplication cyst. These are rare entities in adults and have classically required surgical resection. We describe a novel technique for endoscopic fenestration of the cyst in order to create an asymptomatic esophageal diverticulum.

While surgery has been the preferred management method for symptomatic esophageal duplication cysts, this is likely not necessary in the age of therapeutic endoscopy. A skilled interventional endoscopist may carefully unroof the cyst and avoid surgery. The procedure is outpatient and has a low risk for perforation if done correctly.

These cysts should not be merely drained by FNA as the fluid will re-accumulate and the introduction of a needle will also introduce bacteria, putting the patient at risk for infection. Rather, the cyst can be gently fenestrated using  an electrocautery tool such as a needle knife. It is important to give pre-procedural antibiotics to reduce the risk of infection and to clip the base of the cyst to reduce the risk of spontaneous perforation.

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