Endoscopic resection for an esophageal inclusion cyst

A 24-year-old woman complained of intermittent dysphagia for 2 years. She reported a previous medical history of asthma, hyperthyroidism, and myocarditis. Physical examination revealed no special abnormalities. Computed tomography detected a 5.2 × 4.2-cm mass with a clear boundary in the esophagus ([Fig. 1 a]). Endoscopy showed a large lesion 30–34 cm from the incisors ([Fig. 1 b]). Endoscopic ultrasonography confirmed the hypoechoic lesion with hyperechoic foci, originating from the submucosal layer ([Fig. 1 c]). Endoscopic resection was performed for this patient ([Fig. 2], [Video 1]). After submucosal injection at 3 cm proximal to the lesion, a mucosal incision was made using a dual knife. A submucosal tunnel was subsequently created. When the lesion was partially exposed with an insulated-tip knife, it ruptured suddenly and yellow milky fluid flowed out, suggesting an esophageal cyst. The top layer of the cyst was resected using the dual knife. Then, the remaining rest cyst wall was destroyed using electrocoagulation forceps and anhydrous alcohol. The mucosa beyond the cyst was also removed using a snare. There was no bleeding or perforation during the procedure. Histopathology showed a pseudostratified ciliated columnar epithelium-lined cyst wall and no cartilage or bilayer smooth muscle, confirming it was esophageal inclusion cyst. The patient recovered uneventfully. During 2 months of follow-up, the patient reported no further discomfort; endoscopy also showed complete healing of the wound ([Fig. 3]).