Endoscopic resection in treatment of intramural esophageal cysts: Retrospective analysis of 67 cases

Abstract Intramural esophageal cysts (ECs) are rare congenital malformations. This study aimed to investigate clinical characteristics of intramural ECs and evaluated safety and efficacy of endoscopic resection. From August 2012 to June 2024, 67 patients with intramural ECs treated at the Endoscopy Center of Zhongshan Hospital were retrospectively analyzed. Data on baseline characteristics, clinical outcomes, and follow-up were collected. Twenty-nine patients (17 males, mean age 49.8 years) underwent submucosal tunneling endoscopic resection (STER) and 38 patients (26 males, mean age 53.0 years) underwent endoscopic submucosal dissection (ESD) for intramural ECs. Mean specimen sizes were 2.8 ± 0.9 cm and 1.1 ± 0.6 cm, respectively (P < 0.001). The STER group showed longer operative times (51.2 ± 20.6 vs. 32.6 ± 17.5 minutes, P < 0.001) and slower operation speed (0.13 ± 0.09 cm2/min vs. 0.21 ± 0.14 cm2/min, P = 0.032) compared with the ESD group. Complete resection rates for the STER and ESD groups were 82.8% and 94.7%, respectively (P = 0.127). No major adverse events occurred in the groups. Complete resection was achieved in seven cases with extraluminal growth in the STER group without serious complications. During follow-up (median 37 months and 46 months, respectively), no local recurrence or strictures were observed in either group. Endoscopic resection of intramural ECs is safe and effective with fairly good long-term follow-up outcomes. The STER technique has advantages of completely resecting intramural esophageal cysts originating from the deep muscularis propria layer, particularly lesions with extraluminal growth.