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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.
Figure 1A, The gastrocolonic fistula seen from the stomach. B, Fistula tract being ablated from the colonic side. C, Fistula closed on follow up.
