A 55-year-old man with metastatic esophageal adenocarcinoma presented because of severe diarrhea and malnutrition. He had previously undergone placement of an esophageal stent, after which he experienced sepsis and stent migration. His stent was removed, and he started having diarrhea and became severely malnourished. He was treated with total parenteral nutrition. An upper endoscopy identified a gastrocolonic fistula (Fig. 1). He was a poor surgical candidate, so he was offered endoscopic repair, which consisted of mucosal ablation of the fistula tract and multilayer closure with suturing and over-the-scope clipping (Video 1, available at www.giejournal.org). His diarrhea resolved. He gained 20 kg, and total parenteral nutrition was discontinued. He was able to resume systemic chemotherapy to which he initially responded. Seven months later, his cancer progressed, including malignant infiltration of the gastric wall and recurrence of the fistula. An endoscopy was planned to attempt repair; however, he experienced urosepsis and worsening debilitation and was referred to hospice. In conclusion, a gastrocolonic fistula is a rare adverse event of esophageal stenting. Successful endoscopic repair, consisting of mucosal ablation of the fistula tracts and multilayer closure with suturing and over-the-scope clipping, improved this patient’s nutritional status and quality of life until he succumbed to his disease.
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Published online: March 26, 2016Todd H. Baron, MD, G. S. Raju, MD, Editors for VideoGIE
Copyright © 2016 by the American Society for Gastrointestinal Endoscopy