Post written by Shanshan Shen, MD, PhD, from the Department of Gastroenterology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.

A 50-year-old woman with refractory vomiting and severe electrolyte imbalance was diagnosed with a cystic-communicating duodenal duplication causing duodenal obstruction. As the patient declined surgical intervention, we performed EUS-guided duodenojejunostomy (EUS-DJ).

Under the guidance of EUS, a 19-gauge needle was used to puncture the jejunum via the duodenal cavity, followed by placement of a 15 × 10-mm lumen-apposing metal stent to establish a duodenojejunal bypass. The patient resumed oral intake by postoperative day 3 and was discharged on day 5. One-month imaging confirmed stent patency and resolution of fluid accumulation. She remained symptom-free at 3-month follow-up.

Duodenal duplication cysts account for 2% to 12% of GI duplications, classified as tubular, cystic-communicating, or cystic-noncommunicating. Although endoscopic management has been reported for noncommunicating cysts, deroofing or excision is generally unsuitable for cystic-communicating types, particularly in cases of large cysts with complex anatomy.

This case illustrates that EUS-DJ is a feasible, minimally invasive, and organ-preserving treatment for cystic-communicating duodenal duplication, particularly in patients with systemic adverse events who are unfit or unwilling to undergo surgery.

Other endoscopists can learn from this experience that EUS-DJ is an effective minimally invasive and feasible option for managing symptomatic duodenal duplication cysts, especially in patients who are poor surgical candidates or who decline surgery.

An endoscopic ultrasound (EUS)-guided duodenojejunostomy was performed for duodenal duplication. A, A guidewire was first advanced across the stricture into the distal jejunum. B, Contrast imaging confirmed the distended jejunum after injecting a mixture of methylene blue and sterile water. C, After confirming the puncture site under EUS guidance, we used a 19-gauge needle to puncture the jejunum via the duodenal cavity. D, A 15 × 10-mm lumen-apposing metal stent was used to establish a duodenojejunal bypass.

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