Endoscopic treatment of a duodenal duplication cyst.

A young lady presented to the emergency department with pain in the abdomen for 1 day. She had a history of similar pain in the past. Her clinical examination was unremarkable, except for mild abdominal tenderness. Further investigations suggested diagnoses of acute pancreatitis and a duodenal cyst. Magnetic resonance cholangiopancreatography (MRCP) revealed a cystic lesion in the duodenum in close proximity to the common bile duct (CBD) and the main pancreatic duct (MPD) (●" Fig.1 and●" Fig.2). The patient improved with supportive care. An endoscopic ultrasound (EUS), performed after recovery, revealed a cystic lesion with typical layered appearance suggestive of bowel wall in the second part of duodenum. The CBD and MPD were proximal to the lesion (●" Fig.3). There were no vessels in the wall or within the cystic lesion. The findings suggested a duodenal duplication cyst. The patient declined surgery and opted to undergo endoscopic drainage. The procedure is shown in●" Video 1. An attempt was made to deroof the cyst using an oval snare (SJQ-29-2 Jumbo; Cook Medical Systems, Winston-Salem, North Carolina, USA). The snare could only be applied over part of the cyst wall, which led to only partial deroofing without drainage. The cyst wall was then punctured with a cystotome (Cook Medical Systems). The current was supplied with the Endocut I mode (Erbe Medical Systems, Tübingen, Germany; duration 3 seconds/interval 3 seconds). A guidewire was placed into the cyst and the cyst wall was Fig.1 Magnetic resonance cholangiopancreatography (MRCP) showing a clearly demarcated, smoothwalled cystic lesion in proximity to the distal end of the common bile duct (CBD) and main pancreatic duct (PD), and closely related to the second part of the duodenum, suggesting an intraduodenal location.