Congenital Esophageal Muscularis Propria Defect Found during Endoscopic Submucosal Dissection for Early Esophageal Cancer: A Case Report and Management

TL;DR

A rare congenital defect in the esophagus was found during a cancer procedure and successfully treated without surgery.

Contribution

Demonstrates effective endoscopic management of a rare muscularis propria defect during ESD.

Findings

A translucent submucosal membrane was identified as a congenital muscularis propria defect during ESD.

Endoscopic closure with endoclip-nylon loop prevented complications and avoided surgery.

The patient had no stenosis or diverticulum at 3-month follow-up.

Abstract

Congenital esophageal muscularis propria defects are extremely rare, often complicating endoscopic submucosal dissection (ESD) for esophageal neoplasms. We report a 60‐year‐old man with early esophageal squamous cell carcinoma who underwent ESD. Intraoperatively, a congenital muscularis propria defect was incidentally identified as a translucent, respiration‐synchronized submucosal membrane, which exposed mediastinal structures after perforation. The defect was successfully managed via endoscopic endoclip‐nylon loop purse‐string closure. The patient recovered uneventfully, with pathologically confirmed negative margins and no diverticulum or stenosis at 3‐month follow‐up endoscopy. This case highlights that timely endoscopic recognition and management of such defects during ESD can avoid surgical intervention and ensure favorable outcomes, providing practical insights for endoscopists.

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