Endoscopic submucosal tunnel dissection of a bronchogenic esophageal cyst.

A 23-year-old man was admitted to our hospital with the complaint of chest discomfort and dyspnea for the previous 3 months. Upper endoscopy showed a 2.5×2.0cm bulging lesion in the distal esophagus (●" Fig.1). Endoscopic ultrasound revealed a 1.1×2.5cm hypoechoic cystic lesion arising from the muscularis propria (●" Fig.2). Endoscopic submucosal tunnel dissection (ESTD) was performed using a hybrid knife (ERBE, Tübingen, Germany), and a cystic mass was observed between the mucosa and the muscular layers of the esophagus. On locating the cyst, its yellowish milky fluid content was aspirated. The cyst wall was excised using endoscopic argon plasma coagulation (●" Fig.3). Histopathological examination showed a cuboidal epithelium lined cyst wall, which contained cartilage and a few bronchial glands, consistent with a bronchogenic cyst (●" Fig.4). The patient remained asymptomatic during follow-up. The bronchogenic cyst is thought to be a congenital lesion that arises from the primitive foregut with abnormal budding [1]. It has been reported to occur in the mediastinum, lung parenchyma, pericardium, thymus, and so on [1,2], but the esophageal type is uncommon [2]. At present, complete surgical excision of the cysts by thoracotomy or thoracoscopy is recommended [3]. Sashiyama et al. pubFig.3 Endoscopic submucosal tunnel dissection of the bronchogenic esophageal cyst. a An esophageal submucosal tunnel was created. b After incision of the cyst, its yellowish milky fluid content spurted out and was aspirated. c The cyst wall was excised using endoscopic argon plasma coagulation. d Endoclips were used to close the entrance to the submucosal tunnel. Fig.2 Endoscopic ultrasound showing a 1.1×2.5cm hypoechoic cystic lesion arising from the muscularis propria.