Endoscopic Cyst Esophagostomy Using a Lumen-Apposing Stent for a Large Mediastinal Pancreatic Pseudocyst Compressing the Left Atrium

Pancreatic pseudocysts and peripancreatic fluid collections extending into the mediastinum are unusual. Endoscopically, intra-abdominal pseudocysts can be drained transmurally through the stomach or duodenum depending on the location. An endoscopic ultrasound-guided esophageal approach for mediastinal pseudocysts has not been reported commonly in the literature. We report a rare case of a large mediastinal pseudocyst that was drained through the distal esophagus with eventual complete resolution of symptoms and pseudocyst.