Endoscopic fenestration of a duodenal duplication cyst to resolve recurrent pancreatitis

Abstract

Non-invasive tools such as endoscopic ultrasound and magnetic resonance cholangiopancreatography have assisted the diagnosis of unexplained or recurrent acute pancreatitis prior to endoscopic retrograde cholangiopancreatography (ERCP). The majority of these patients are improved by endoscopic therapy with ERCP. Duodenal duplication cyst is a known but rare cause of recurrent acute pancreatitis that is also amenable to ERCP. We document the diagnosis and treatment of a 26-year-old man who had six episodes of pancreatitis that were found to be due to a duodenal duplication cyst. The pancreatico-biliary tree emptied into the cyst, which caused episodic obstruction and reflux contaminated juice resulting in pancreatitis. The patient also complained of persistent epigastric discomfort between attacks. Video demonstration of the technique for fenestration of the cyst is presented. Free emptying of bile and pancreatic juice from the cyst has resulted in elimination of the patient's persistent epigastric discomfort and attacks of pancreatitis.