Factors Favoring Esophagectomy for Communicating Duplication Cysts

A 54-year-old female patient presented with a symptomatic esophageal diverticulum. Endoscopy and biopsy confirmed a communicating esophageal duplication cyst with Barrett metaplasia and low-grade dysplasia. There was no evidence of fluorodeoxyglucose avidity on the preoperative positron emission tomography scan. Given recent trends towards esophageal preservation and absence of definitive cancer, cyst resection was planned. Final pathology revealed invasive adenocarcinoma; thus, esophagectomy was performed. We present a rare case of an esophageal duplication cyst progressing to invasive adenocarcinoma, focusing on the key surgical decision points in balancing oncologic control and esophageal preservation.