先进的内镜技术治疗食道重复囊肿：超越手术

Q3 Medicine

VideoGIE Pub Date : 2025-02-21 DOI:10.1016/j.vgie.2025.02.002

Radhika Chavan MD, DNB , Zaheer Nabi MD, DNB , Sukrit Sud MD, DM , Chaiti Gandhi MD, DNB , Sanjay Rajput MD, DM , D. Nageshwar Reddy MD, DM

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引用次数: 0

摘要

背景和目的食道重复囊肿是一种罕见的先天性异常，其特征为上皮内膜和肌壁。如今，由于胃镜和横断面成像的使用增加，食管重复囊肿越来越多地被发现。虽然手术仍然是标准的治疗方法，但对于有症状的患者或不愿或不适合手术的患者，endotherapy已经成为一种可行的微创治疗方法。内镜入路包括切除、开窗、减压和粘膜下隧道内镜切除（STER）。方法回顾性分析3例采用先进内镜技术治疗的有症状的食管重复囊肿。通过胃镜检查和EUS确诊。EUS显示粘膜下囊性病变，伴有特征性的后侧声增强。内镜技术包括STER，以及联合EUS和内镜开窗的混合技术。所有手术均在镇静或全身麻醉下进行，并在术后1、6和12个月进行监测和随访。结果介绍了三种内镜下治疗食管重复囊肿的方法，均取得成功。1例患者因有症状的小食管中囊肿行STER手术。对2例患者采用2种技术(1)导丝为导向结构，(2)塑料支架为导向结构，采用EUS与内镜下开窗相结合的混合技术。在中位随访12个月时，所有3例患者均无症状。结论先进的内镜治疗，包括混合技术，为治疗食管重复囊肿提供了一种有效的、微创的替代方法。这些程序能够精确开窗并减少不良事件。对于具有外生性成分的大囊肿，手术风险高的患者可考虑采用混合手术。需要更大样本量和长期随访的进一步研究来验证这些有希望的结果。

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Advanced endoscopic techniques for esophageal duplication cyst treatment: beyond surgery

Background and Aims

Esophageal duplication cysts are rare congenital anomalies characterized by an epithelial lining and muscular wall. Nowadays, esophageal duplication cysts are increasingly detected because of increased use of gastroscopy and cross-sectional imaging. Although surgery remains the standard treatment, endotherapy has emerged as a viable minimally invasive alternative, particularly for symptomatic patients or those unwilling or unfit for surgery. Endoscopic approaches include resection, fenestration, decompression, and submucosal tunneling endoscopic resection (STER).

Methods

This case series reviews 3 patients with symptomatic esophageal duplication cysts managed using advanced endoscopic techniques. Diagnosis was confirmed using gastroscopy and EUS. EUS demonstrated cystic lesions of submucosal origin with characteristic posterior acoustic enhancement. Endoscopic techniques included STER, and hybrid techniques combining EUS with endoscopic fenestration. All procedures were performed with the patient under sedation or general anesthesia, with postprocedure monitoring and follow-up at 1, 6, and 12 months.

Results

Three endoscopic techniques of esophageal duplication cysts are described with successful results. STER was performed in 1 patient for a small symptomatic midesophageal cyst. Hybrid technique combining EUS and endoscopic fenestration was performed in 2 patients by 2 techniques: (1) guidewire as guiding structure and (2) plastic stent as guiding structure. All 3 patients remained asymptomatic at a median follow-up of 12 months.

Conclusions

Advanced endotherapy, including hybrid techniques, offers an effective, minimally invasive alternative to surgery for managing esophageal duplication cysts. These procedures enable precise fenestration and reduce adverse events. Hybrid procedures can be considered for large cysts with exophytic components in patients at a high risk for surgery. Further studies with larger sample sizes and long-term follow-up are needed to validate these promising outcomes.

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来源期刊

VideoGIE Medicine-Gastroenterology

CiteScore

1.50

自引率

0.00%

发文量

132

审稿时长

105 days

期刊介绍： VideoGIE, an official video journal of the American Society for Gastrointestinal Endoscopy, is an Open Access, online-only journal to serve patients with digestive diseases. VideoGIE publishes original, single-blinded peer-reviewed video case reports and case series of endoscopic procedures used in the study, diagnosis, and treatment of digestive diseases. Videos demonstrate use of endoscopic systems, devices, and techniques; report outcomes of endoscopic interventions; and educate physicians and patients about gastrointestinal endoscopy. VideoGIE serves the educational needs of endoscopists in training as well as advanced endoscopists, endoscopy staff and industry, and patients. VideoGIE brings video commentaries from experts, legends, committees, and leadership of the society. Careful adherence to submission guidelines will avoid unnecessary delays, as incomplete submissions may be returned to the authors before initiation of the peer review process.