Will Uwe, Meyer Frank, Bosseckert Hans
Department of Internal Medicine III, City Hospital, Gera, Germany.
Scand J Gastroenterol. 2005 Aug;40(8):995-9. doi: 10.1080/00365520510023125.
Duplication cysts of the gastrointestinal tract are rare, particularly in adults. Endoscopic minimally invasive treatment is still a challenging approach even in the endoscopically accessible sections of the gastrointestinal tract. In a 25-year-old patient suffering from dysphagia, an endoscopy and subsequent endosonography revealed a spherical duplication cyst in the lower third of the esophagus, which prompted us to puncture the cyst and subsequently to perform a fenestration (marsupialization; diameter 1 cm) in the anterior wall of the cyst, resulting in permanent drainage of the cystic fluid. Because of the recurrent complaints of the patient after 6 weeks, the anterior wall of the duplication cyst, the former esophageal wall, was partially resected, resulting in a permanent 4-cm opening including the cystic cavity into the esophageal lumen. Thereafter, there were no further complaints from the patient and the findings in the follow-up endoscopy were normal. A successful endoscopic intervention for this type of gastrointestinal duplication cyst is described for the first time. The minimally invasive resection of the anterior wall of the esophageal duplication cyst, simultaneously with the former regular wall at this segment of the esophagus, resulted in permanent inclusion of the cystic cavity into the esophageal lumen with no disadvantageous passage of fluid and food through the lower esophagus or changes in the former cystic epithelium. This method is considered to be feasible and a reasonable treatment alternative to the more invasive surgical approach.
胃肠道重复囊肿很少见，尤其在成人中。即使在胃肠道内镜可及的部位，内镜微创治疗仍然是一种具有挑战性的方法。在一名25岁吞咽困难的患者中，内镜检查及随后的超声内镜检查发现食管下三分之一处有一个球形重复囊肿，这促使我们对囊肿进行穿刺，并随后在囊肿前壁进行开窗（袋形缝合术；直径1cm），使囊液得以永久引流。由于6周后患者再次出现不适，对重复囊肿的前壁，即原来的食管壁进行了部分切除，形成了一个4cm的永久性开口，包括囊肿腔通向食管腔。此后，患者未再有不适，随访内镜检查结果正常。首次描述了针对此类胃肠道重复囊肿的成功内镜干预。食管重复囊肿前壁与该段食管原来的正常壁同时进行微创切除，使囊肿腔永久纳入食管腔，且不会出现液体和食物通过食管下段的不利情况，也不会使原来的囊肿上皮发生改变。该方法被认为是可行的，并且是比更具侵入性的手术方法更合理地治疗选择。
