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DOI: 10.1055/s-0032-1309705
Complete endoscopic management of tubular esophageal duplication in a young woman
Publikationsverlauf
Publikationsdatum:
13. Juli 2012 (online)
![](https://www.thieme-connect.de/media/endoscopy/2012S02/lookinside/thumbnails/10.1055-s-0032-1309705-1.jpg)
A 29-year-old woman was referred to our department for endoscopic dilation of upper esophageal stricture. Dilation was performed with Savary–Gilliard dilators allowing the passage with resistance of a standard flexible video gastroscope (EG-201FP; Fujinon, Willich, Germany). Esophagogastroduodenoscopy showed a double esophageal lumen at 18 cm from the incisors. A thick bridge of intact mucosa separated the two lumens ([Fig. 1]). The passage of the endoscope through the second lumen was not possible. At 32 cm, a distal defect was also found. A barium esophagogram and high-resolution computed tomography (CT) scan confirmed esophageal tubular duplication ([Fig. 2] and [Fig. 3]).
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![](https://www.thieme-connect.de/media/endoscopy/2012S02/thumbnails/274cl2.jpg)
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Under general anesthesia, the standard video gastroscope was pushed down to the proximal opening of the duplication. After an easy passage of a 0.035-inch guide wire (Boston Scientific, Natick, MA, USA) in the duplicated lumen, a lengthwise incision of the intraluminal bridge was performed by using a 5.5-Fr needle-knife (microKnife XL; Boston Scientific).The incision was performed step by step, from the upper to the distal end ([Fig. 4], [Videos 1 – 3]). The procedure was completed with dilation of the upper esophageal stricture by using a wire-guided balloon (Boston Scientific) advanced through the endoscope and expanded up to 12 mm.
![](https://www.thieme-connect.de/media/endoscopy/2012S02/thumbnails/274cl4.jpg)
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Qualität:
Qualität:
Qualität:
Biopsies performed along the incision showed the presence of malpighian epithelium. The patient’s early post-procedural course was marked by an iatrogenic mediastinal emphysema and bilateral pneumothorax, more pronounced in the left. The placement of a left chest drain led to rapid improvement. Upper endoscopy on day 20 showed two longitudinal residual folds ([Fig. 5]).
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Endoscopic management of esophageal duplication was reported twice previously for the cystic form [1] [2]. To our knowledge, only one case of endoscopic management of a tubular esophageal duplication has previously been reported [3]. Nevertheless, the procedure was decided upon after surgical examination through a right thoracoscopy. Our case highlights the possibility of complete endoscopic management of tubular esophageal duplication. The post-procedure pneumothorax could have been avoided by carbon dioxide insufflation [4].
Endoscopy_UCTN_Code_TTT_1AO_2AN
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References
- 1 Will U, Meyer F, Bosseckert H. Successful endoscopic treatment of an esophageal duplication cyst. Scand J Gastroenterol 2005; 40: 995-999
- 2 Joyce AM, Zhang PJ, Kochman ML. Complete endoscopic resection of an esophageal duplication cyst (with video). Gastrointest Endosc 2006; 64: 288-289
- 3 Coumaros D, Schneider A, Tsesmeli N et al. Endoscopic management of a tubular esophageal duplication diagnosed in adolescence (with video). Gastrointest Endosc 2010; 71: 827-830
- 4 Uemura M, Ishii N, Itoh T et al. Effects of carbon dioxide insufflation in esophageal endoscopic submucosal dissection. Hepatogastroenterology 2011; 14: 115-116