S4261 Endoscopic Diagnosis of Esophageal Cancer Complicated by Esophagopulmonary Fistula

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 2 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. Case Description/Methods: A 65-year-old man 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 1 ppd for 10 years and had an average BMI. He had no family history of gastrointestinal cancers. Contrast computed tomography scan demonstrated a large heterogeneous enhancing soft tissue mass in the esophagus as well as numerous scattered bilateral pulmonary nodules. Esophagogastroduodenoscopy revealed an esophageal mass extending from 30 cm to the gastroesophageal junction at 39 cm, encompassing 75% of the lumen. While maneuvering around the mass, a pulmonary fistula was observed on the right side of the esophagus at 32 cm. 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.