Endoscopic hybrid resection and under-water snare resection of symptomatic duodenal duplication cysts in children

 

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Duodenal duplication cysts are rare congenital malformations of the gastrointestinal tract, manifested in early childhood [1] [2]. They are benign lesions, although a few cases have been reported including carcinoid tumors, squamous cell carcinomas, and adenocarcinomas [3]. Endoscopic treatments include fenestration, marsupialization, snare resection, and aspiration [4] [5].

We report two cases of endoscopic resection of duodenal duplications in children.

The first case is of a 7-year-old boy presenting with abdominal pain and elevated liver enzymes. Magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS) showed a 25-mm duodenal duplication cyst, independent from the common bile duct and pancreatic duct but encompassing the major papilla ([Fig. 1]). We performed endoscopic under-water snare resection of the cyst using a linear EUS scope. The posterior wall of the resected cyst contained the major papilla and a prophylactic pancreatic stent was placed without complication.

The second case was a 2-year-old girl admitted for abdominal pain and vomiting ([Fig. 2], [Fig. 3]; [Video 1]). CT showed jejunal intussusception, which was reduced laparoscopically. MRI and EUS revealed a 40-mm duodenal duplication cyst in the second duodenum, with the major papilla inside. We performed endoscopic hybrid resection, combining circumferential incision of the proximal portion of the cyst (Dual Knife; Olympus, Tokyo, Japan), followed by snare resection using the Olympus PCF 190 TI colonoscope. The remaining duplication mucosa was fixed to duodenal mucosa by clips. In both cases histology confirmed duodenal duplication covered by intestinal mucosa without dysplasia.

Video 1 Endoscopic under-water snare resection and endoscopic hybrid resection of duodenal duplication cysts.

This video shows two different types of resections depending on the presentation of duplication and its links to the duodenal wall. In the first case complete resection was feasible with a snare, but in the second, the duodenal wall appeared incomplete and therefore only complete duplication could be resected using the hybrid technique. These two types of resections avoid the morbidity associated with surgical resection and the necessity of endoscopic follow-up recommended to prevent the risk of malignant transformation in cases of simple fenestration.

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Publication History

Article published online:
14 October 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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