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Cricopharyngeal septal cyst within a Zenker's diverticulum treated with EUS-FNA and endoscopic incisional therapy


1 Division of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA
2 Department of Internal Medicine, Geisinger Medical Center, Danville, Pennsylvania, USA
3 Department of Gastroenterology, UPMC Susquehanna, Williamsport, Pennsylvania, USA
4 Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, New York, USA

Date of Submission10-Feb-2021
Date of Acceptance14-Feb-2022
Date of Web Publication08-Jul-2022

Correspondence Address:
Harshit S Khara,
Division of Gastroenterology and Nutrition, Geisinger Medical Center, 100 N. Academy Avenue, 21-11, Danville 17822, PA
USA
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/EUS-D-21-00053

PMID: 35848653



How to cite this URL:
Khara HS, Khalid A, Al-Salameh N, Basi PS, Kumar V, Kothari ST, Kothari TH. Cricopharyngeal septal cyst within a Zenker's diverticulum treated with EUS-FNA and endoscopic incisional therapy. Endosc Ultrasound [Epub ahead of print] [cited 2022 Aug 13]. Available from: http://www.eusjournal.com/preprintarticle.asp?id=350336

We present a rare case of dysphagia from an obstructing esophageal cyst on the cricopharyngeal septum within a Zenker's diverticulum, successfully treated with EUS-guided cyst drainage, followed by endoscopic incisional therapy of the Zenker's diverticulum.

A 68-year-old female with symptomatic oropharyngeal dysphagia was referred for endoscopic treatment of a suspected Zenker's diverticulum seen on esophagram [Figure 1]a. On endoscopic exam, she was found to have an obstructing submucosal cyst on the cricopharyngeal septum within a large Zenker's diverticulum in the proximal esophagus [Figure 1]b. EUS exam was done to characterize the cystic lesion which showed a 14 mm round anechoic cyst originating in the deep mucosa [Figure 1]c. EUS-guided fine-needle aspiration was performed [Figure 1]d using a 19-G needle (EZ Shot 3 Plus, Olympus America, Center Valley, PA, USA), with decompression of the cyst and subsequent cytology confirming it to be a benign cyst. After cyst decompression, a same session cricopharyngeal septotomy was performed with successful flexible endoscopic incisional therapy of the Zenker's diverticulum using an SB knife (Olympus America, Center Valley, PA, USA) [Figure 1]e. The septotomy defect was closed with two 11 mm endoclips (DuraClip, ConMed, Largo, FL, USA) [Figure 1]f. The patient had complete resolution of her dysphagia with no symptom recurrence at 1-year follow-up.
Figure 1: (a) Esophagram showing Zenker's diverticulum with obstructing cyst. (b) Endoscopic view of the cricopharyngeal septal cyst within the Zenker's diverticulum. (c) Miniprobe EUS view of the Zenker's septal cyst. (d) EUS-FNA of the Zenker's septal cyst. (e) Flexible endoscopic incisional therapy of Zenker's diverticulum with SB knife. (f) Endoclip closure of Zenker's septotomy

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  Discussion Top


Zenker's diverticulum has been successfully treated with surgical and endoscopic techniques, but the presence of incidental cystic lesion[1] or occult malignancy[2],[3] within the Zenker's pouch highlights the need for comprehensive endoscopic evaluation and the use of adjunct tools such as EUS to rule out vascular flow or assist in cyst drainage before endoscopic therapy can be pursued. We report the first case of a cricopharyngeal septal cyst within a Zenker's diverticulum as the cause of symptomatic dysphagia which was successfully treated with the use of EUS-guided cyst drainage and endoscopic incisional therapy in the same session.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lewandowski A, Taboła R, Markocka-Mączka K, et al. Branchial cyst in a Zenker's diverticulum. Adv Clin Exp Med 2008;17:677-9.  Back to cited text no. 1
    
2.
Brücher BL, Sarbia M, Oestreicher E, et al. Squamous cell carcinoma and Zenker diverticulum. Dis Esophagus 2007;20:75-8.  Back to cited text no. 2
    
3.
Hajjar WM, Almutairi OT, Jameel MA, et al. Squamous cell carcinoma arising in Zenker's diverticulum: A case report and review of the literature. Turk Thorac J 2018;19:228-30.  Back to cited text no. 3
    


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