Endoscopic resection in the treatment of intramural esophageal cysts: A retrospective analysis of 67 cases

Background and study aims: Intramural esophageal cysts (ECs) are rare congenital malformations. This study aimed to investigate the clinical characteristics of intramural ECs and evaluate the safety and efficacy of endoscopic resection. Patients and methods: From August 2012 to June 2024, 67 patients with intramural ECs were treated at the Endoscopy Center of Zhongshan Hospital were retrospectively analyzed. Data on baseline characteristics, clinical outcomes, and follow-up were collected. Results: Twenty-nine patients (17 males, mean 49.8 years) underwent submucosal tunneling endoscopic resection (STER) and 38 patients (26 males, mean 53.0 years) underwent endoscopic submucosal dissection (ESD) for intramural ECs. The mean specimen size 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 ± 0.14cm2/min, p=0.032) compared to the ESD group. The complete resection rates of 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 7 cases with extraluminal growth in 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. Conclusions: Endoscopic resection of intramural ECs is safe and effective with fairly good long follow-up outcomes. The STER technique has advantages of completely resecting intramural esophageal cysts originating from the deep muscularis propri layer, particularly those lesions with extraluminal growth.

Publication History

Received: 14 March 2025

Accepted after revision: 05 January 2026

Accepted Manuscript online:
07 January 2026