Contrast-Enhanced Endoscopic Ultrasound for Gastrointestinal Duplication Cysts: Case Report

Gastrointestinal duplication cysts are rare congenital anomalies that are often discovered incidentally. Although asymptomatic cases may not require immediate intervention, optimal management remains controversial, particularly due to concerns regarding malignant potential. This report aims to highlight the diagnostic role of contrast-enhanced endoscopic ultrasound (CE-EUS) and discuss management strategies for asymptomatic gastrointestinal duplication cysts.

A 54-year-old woman was found to have an asymptomatic subepithelial lesion during a routine oesophagogastroduodenoscopy (OGD). Further evaluation with endoscopic ultrasound (EUS) demonstrated a characteristic "gut signature sign". Subsequent contrast-enhanced EUS revealed enhancement limited to the cyst wall, supporting the diagnosis of a duplication cyst. The patient remained asymptomatic throughout the evaluation period.

Over two years of follow-up, serial EUS examinations demonstrated no significant changes in the size or characteristics of the lesion. No clinical symptoms developed, and no features suggestive of malignant transformation were identified.

This case illustrates the utility of CE-EUS as a safe and effective diagnostic alternative to EUS-guided fine needle biopsy for gastrointestinal duplication cysts. The findings support a conservative management approach with careful EUS surveillance for asymptomatic lesions, reserving surgical intervention for symptomatic cases. A tailored strategy based on clinical presentation and lesion characteristics may optimize patient outcomes.