Gastrointestinal Duplication Cysts

8/12/2019 Gastrointestinal Duplication Cysts

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Hasan Ashraf, MSIII

Pediatric Surgery


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What are duplication cysts? Duplication cysts are generally benign and rare

anomalies that arise during embryonic development

Coined by Ladd in 1937 which included 3characteristics: (1) ) the epithelial lining representssome portion of the alimentary tract, (2) a well-developed coat of smooth muscle is present, and (3)the duplications were attached to some portion of the

GI tract Two broad categories: (1) those that are adjacent to the

lumen and (2) those that are tubular andcommunicated directly with the lumen


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Epidemiology Observed in 1/4500 autopsies

Predominantly in white males

Small intestine is most frequent site involved (44%),followed by colonic (15%), though thoracic, gastric,and rectal duplications have been observed


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EtiologyExact etiology unknown; several theories have beenproposed:

(1) the initial developmental abnormality occurs duringthe gastrulation stage and results in a split notochordwith persistence of an endomesenchymal tract

(2) partial twinning theory(3) Intrauterine environmental during a vascularaccident


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Symptoms and Complications of

Duplication Cysts Usually asymptomatic in small intestine; depends on

size and location of the duplication

Esophageal duplication cysts frequently causesymptoms unlike intestinal duplications: dysphagia,respiratory symptoms, and abdominal pain

Duodenal duplications may contain ectopic gastric

mucosa which predisposes to ulceration Other symptoms include hematemesis and

pancreatitis

Case reports have described malignant transformation


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Diagnosis of Duplication Cysts

Usually found incidentally onendoscopy or radiologic imaging

Most commonly diagnosed by CT orMRI since they are infrequentlyseen endoluminally

Endoscopic appearance: appear as a

bulge with normal overlyingmucosa or as a diverticulum


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Endosonographic findings:anechoic homogenous lesions

with regular margins arisingfrom the submucosa orextrinsic to the GI wall.

Endosonography is beneficialin discriminating aduplication cyst from a solidmass

EUS guided FNA can be used

for esophageal duplicationsthough this is not necessaryand has complications


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Management May be expectant

Evaluation before surgery based on blood supply

Resection in asymptomatic cases for most GIduplications recommended in recent years based onpossibility of malignant transformation and othercomplications

Duodenal and complex tubular colonic duplicationsare exceptions

Resection in symptomatic cases via surgery orendoscopy


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References Banner K, Helft S, et al, An unusual cause of dysphagia in a young woman:

esophageal duplication cyst, Gastrointest Endosc. 2008;68(4):793 Coit DG, Mies C, Adenocarcinoma arising within a gastric duplication cyst,J

Surg Oncol. 1993;50(4):274 Chiu AS, et al, Enteric Duplication Cyst of the Pancreas Associated with

Chronic Pancreatitis and Pancreatic Cancer,J Gastrointest Surg. 2012;23(93):343 Faigel DO, Burgke A, Ginsberg GG, et al, The role of endoscopic ultrasound in

the evaluation and managemen of foregut duplications, Gastrointest Endosc.1997;45(1):99

Geller A, Wang KK, et al, Diagnosis of foregut duplication cysts by endoscopicultrasonography, Gastroenterology. 1995;109(3):838

Van Dam J, Rice TW, Sivak MV Jr, Endoscopic ultrasonography andendoscopically guided needle aspiration for the diagnosis of uppergastrointestinal tract foregut cysts,Am J Gastroenterol.1992;87(6):762

Woolfolk GM, McClave SA, Use of endoscopic ultrasound to guide diagnosisand endoscopic management of a large gastric duplication cyst, GastrointestEndosc. 1998;47(1):76

Gastrointestinal Duplication Cysts

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