Ma JM, Ji CG, Liu L, Yin KG. Bronchogenic cysts treated with submucosal tunneling endoscopic resection and natural orifice transluminal endoscopy: Two case reports and review of literature. World J Gastrointest Endosc 2026; 18(4): 117233 [DOI: 10.4253/wjge.v18.i4.117233]
Corresponding Author of This Article
Li Liu, MD, Chief Physician, Professor, Endoscopy Center, Luquan Campus, The Second Hospital of Hebei Medical University, No. 501 Huai’an West Road, Shijiazhuang 050000, Hebei Province, China. loraliu@163.com
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Gastroenterology & Hepatology
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Case Report
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Apr 16, 2026 (publication date) through Apr 16, 2026
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World Journal of Gastrointestinal Endoscopy
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1948-5190
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Ma JM, Ji CG, Liu L, Yin KG. Bronchogenic cysts treated with submucosal tunneling endoscopic resection and natural orifice transluminal endoscopy: Two case reports and review of literature. World J Gastrointest Endosc 2026; 18(4): 117233 [DOI: 10.4253/wjge.v18.i4.117233]
World J Gastrointest Endosc. Apr 16, 2026; 18(4): 117233 Published online Apr 16, 2026. doi: 10.4253/wjge.v18.i4.117233
Bronchogenic cysts treated with submucosal tunneling endoscopic resection and natural orifice transluminal endoscopy: Two case reports and review of literature
Jie-Min Ma, Chen-Guang Ji, Li Liu, Kai-Ge Yin
Jie-Min Ma, Chen-Guang Ji, Li Liu, Kai-Ge Yin, Endoscopy Center, Luquan Campus, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
Co-first authors: Jie-Min Ma and Chen-Guang Ji.
Co-corresponding authors: Li Liu and Kai-Ge Yin.
Author contributions: Liu L and Yin KG performed the endoscopic procedures and provided critical technical guidance, revised the manuscript for important intellectual content and they contributed equally to this manuscript and are co-corresponding authors; Ma JM and Ji CG collected the clinical data, reviewed the literature, drafted the manuscript, and conducted patient follow-up and they contributed equally to this manuscript and are co-first authors. All authors have read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Li Liu, MD, Chief Physician, Professor, Endoscopy Center, Luquan Campus, The Second Hospital of Hebei Medical University, No. 501 Huai’an West Road, Shijiazhuang 050000, Hebei Province, China. loraliu@163.com
Received: December 2, 2025 Revised: January 19, 2026 Accepted: March 13, 2026 Published online: April 16, 2026 Processing time: 132 Days and 18.6 Hours
Abstract
BACKGROUND
Bronchogenic cysts (BCs) are congenital lesions typically located in the mediastinum. Although benign, BCs may cause complications due to infection or compression. Surgical resection remains the standard treatment, but traditional approaches are often traumatic. When closely adjacent to the esophageal wall, BCs may be misdiagnosed as intramural submucosal lesions. The combined application of submucosal tunneling endoscopic resection (STER) and natural orifice transluminal endoscopic surgery offers a minimally invasive treatment for such extramural lesions.
CASE SUMMARY
We present two cases of young adults in whom lower esophageal submucosal lesions were incidentally detected during routine health examinations. Preoperative computed tomography and initial endoscopic ultrasonography suggested that both lesions originated from the muscularis propria of the esophagus. Accordingly, STER was selected as the initial therapeutic strategy. However, after reaching the muscularis propria within the submucosal tunnel, no intramural lesion was identified. Subsequent intraoperative endoscopic ultrasonography re-evaluation demonstrated cystic lesions located in the posterior mediastinum in both patients. The procedural strategy was therefore promptly adjusted, and a combined STER-natural orifice transluminal endoscopic surgery approach was adopted. The esophageal muscularis propria was carefully incised at the estimated lesion site to gain mediastinal access, allowing successful en bloc resection of one cyst in each case. Histopathological analysis confirmed BCs. No intraoperative complications occurred, and both patients recovered uneventfully and were discharged in stable condition.
Core Tip: Mediastinal bronchogenic cysts adjacent to the esophagus can closely resemble submucosal esophageal lesions on preoperative imaging, posing diagnostic challenges. We describe two cases managed using a transesophageal mediastinal tunneling technique that integrates submucosal tunneling endoscopic resection with natural orifice transluminal endoscopic surgery. This innovative, minimally invasive approach allows precise intraoperative identification, complete en bloc cyst excision, and excellent postoperative recovery while avoiding thoracotomy.
