Endoscopic management of a tubular esophageal duplication diagnosed in adolescence (with videos)

Background: Esophageal duplication is a rare congenital lesion. Surgery is the standard treatment Tubular duplication is extremely rare, with esophageal communication in very few cases. Objective: The aim of this study was to document the feasibility of the endoscopic management of tubular esophageal duplication. Design: Case report. Intervention: A 14-year-old boy presented with acute dysphagia and acute retrosternal pain. Based on his radiographic and endoscopic findings, a cystic esophageal duplication with an upper esophageal stricture was initially suspected. A laparoscopic gastrostomy was performed. A cyst resection through right thoracoscopy assisted by flexible endoscopy was decided upon. When no extraluminal cystic duplication was found, a tubular duplication was considered and the procedure was abandoned. An endoscopic treatment was performed. A standard endoscope was inserted through an upper esophageal stricture. Two lumens were identified 25 cm from the incisors. A pediatric endoscope was passed through the main one, revealing a thick intraluminal bridge. By using a guidewire, the endoscope's passage into the narrow lumen revealed a distal communication with the esophagus. With the guidewire left in place, the endoscope was reintroduced into the main lumen. A lengthwise incision of the bridge was performed by using a needle knife. At the end of the procedure, an esophageal dilation was performed. Histology confirmed the diagnosis of duplication. Results: The endoscopic incision of the duplication was completed uneventfully. For 11 months, the patient followed a normal diet and experienced no symptoms. Limitations: Single case. Conclusion: To our knowledge, this is the first report of successful endoscopic incision of a total tubular esophageal duplication.