Asli Tahan, 1, Ervin Tahan, 1, Muhammad F.. Mubarak, MBBS2 1University of Missouri, Columbia, MO; 2King Saud University, Los Angeles, CA Introduction: Esophagopulmonary fistula is an overwhelming complication of advanced esophageal cancer (EC). Embryonically, the trachea and the esophagus are both derived from the foregut. When these two structures meet again, they impact oral feeding and quality of life. This structural connection during development likely causes future malignant invasion into the respiratory tract. Here, we present a rare condition of EC complicated by esophagopulmonary fistula, which was diagnosed with esophagogastroduodenoscopy (EGD).
Case Description/
Methods: A 65-year-old male presented with progressive dysphagia for 4 weeks. Past medical history significant for hypertension and hiatal hernia diagnosed 20 years ago. He was a former smoker 1ppd for 10 years and had an average BMI. He had no family history of gastrointestinal cancers. Contrast CT scan demonstrated a large heterogeneous enhancing soft tissue mass in the esophagus as well as numerous scattered bilateral pulmonary nodules.
EGD revealed an esophageal mass extending from 30cm to the GEJ at 39cm, encompassing 75% of the lumen. While maneuvering around the mass, a pulmonary fistula was observed on the right side of the esophagus at 32cm. Given the location and the images obtained, this is believed to connect the esophagus to the right middle lobe bronchus. The biopsies of the mass were consistent with esophageal adenocarcinoma. The patient wanted palliative care only after a covered metal stent placement. Discussion: ECs are more aggressive and likely diagnosed at later stages when the chance for complications is increased namely esophagopulmonary fistulas. Screening in this population is of utmost concern. This case serves as a reminder to strengthen relationships with primary care providers in order to discover more esophageal cancer cases in their earlier stages thereby increasing the 5-year survival rate. The use of covered expandable metallic stents is feasible for feeding and safe to prevent aspiration from the fistula tract for the palliative treatment.
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Disclosures: Asli Tahan indicated no relevant financial relationships. Ervin Tahan indicated no relevant financial relationships. Muhammad Mubarak indicated no relevant financial relationships.
Asli Tahan, 1, Ervin Tahan, 1, Muhammad F.. Mubarak, MBBS2. P0758 - Endoscopic Diagnosis of Esophageal Cancer Complicated by Esophagopulmonary Fistula, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
