From the Guidelines
Duplication cysts should be treated with surgical excision if symptomatic, as this approach prioritizes minimizing morbidity, mortality, and optimizing quality of life. A duplication cyst is a rare congenital anomaly that forms during embryonic development when a portion of the gastrointestinal tract duplicates abnormally. These cysts can occur anywhere along the digestive tract from the mouth to the anus, but most commonly affect the ileum, followed by the esophagus, colon, jejunum, stomach, and duodenum. Duplication cysts typically share a common wall with the adjacent normal bowel and may or may not communicate with the intestinal lumen. They contain mucosa similar to that of the adjacent gastrointestinal tract, though sometimes they may contain ectopic tissue such as gastric, pancreatic, or respiratory epithelium. Symptoms vary depending on location and size but can include abdominal pain, nausea, vomiting, intestinal obstruction, bleeding, or a palpable mass. In some cases, they remain asymptomatic and are discovered incidentally.
The diagnosis of a duplication cyst can be made using endoscopic ultrasonography (EUS), which will show an anechoic, smooth, spherical, or tubular structure with a well-defined wall 1. If the cystic structure is adjacent to the pancreas, EUS/FNA can be performed to sample the fluid contents of the cyst to rule out a pancreatic pseudocyst or a pancreatic cystic neoplasm. However, according to the most recent guidelines, EUS-FNA is often not required to establish the diagnosis and should be avoided for mediastinal lesions because mediastinitis is a recognized complication 1.
Key considerations in the management of duplication cysts include:
- Surgical excision is the recommended treatment for symptomatic duplication cysts, which typically involves complete removal of the cyst while preserving the adjacent normal bowel.
- In cases where complete excision might damage vital structures, partial excision with mucosal stripping may be performed.
- The prognosis after surgical removal is generally excellent, though patients should be monitored for potential complications such as infection or recurrence.
- Early diagnosis and treatment are important as some duplication cysts have malignant potential, particularly in adults.
- Asymptomatic duplication cysts do not require surveillance, according to the most recent clinical practice update 1.
From the Research
Diagnosis of Duplication Cysts
- Duplication cysts are rare congenital anomalies of the alimentary tract, and their diagnosis can be challenging due to variable clinical presentations depending on size, location, and mass effect 2, 3.
- Imaging investigations such as abdominal ultrasonography, CT scans, and endoscopic ultrasound are crucial in establishing the diagnosis of duplication cysts 2, 4, 5.
- Histopathological analysis is necessary to confirm the diagnosis of a duplication cyst, and it can help identify potential risks of malignant transformation 2, 4, 5.
Treatment of Duplication Cysts
- The standard treatment of choice for symptomatic enteric duplication cysts is complete surgical removal, which can be done through open surgery or laparoscopic surgery 2, 3, 4.
- Laparoscopic surgery is a minimally invasive approach that can be used for the resection of duplication cysts, and it is favorable for intraoperative inspection 4, 5.
- In some cases, endoscopic removal of duplication cysts may be possible, especially for cysts that are causing outlet obstruction symptoms 6.
- The surgical approach may vary depending on the location and size of the cyst, as well as the presence of any complications such as malignancy or abscess formation 3, 5.
Considerations for Duplication Cysts
- Duplication cysts have the potential risk of malignant transformation, and complete removal of the cyst is recommended to prevent this risk 2, 4.
- Duplication cysts can cause symptoms such as abdominal pain, intestinal obstruction, and dysphagia, and prompt diagnosis and treatment are necessary to prevent complications 2, 3, 5.
- A thorough understanding of the clinical characteristics, diagnosis, and treatment of duplication cysts is essential for healthcare professionals to provide appropriate care for patients with these rare congenital anomalies 3, 4.