Fistulizing, Lower Esophageal Squamous Cell Carcinoma After Heller Myotomy With Fundoplication in a Patient With Achalasia

Achalasia is a premalignant condition with higher risk of esophageal squamous cell carcinoma (ESCC), but there is a lack of consensus on surveillance protocol need because of inconsistent data regarding the increased risk of ESCC in these patients compared to the general population. ESCC is generally proximally located and less common than esophageal adenocarcinomas. Although most ESCC in patients with a history of achalasia are found in the middle third of the esophagus, patients who underwent surgical intervention resulting in a modified anatomy of the esophagus and the upper stomach may have a different presentation and endoscopic findings. Unfortunately, the diagnosis of ESCC may be delayed as symptoms of achalasia and esophageal carcinomas may overlap. To our knowledge, this case represents the first reported instance of a patient with distal ESCC with fistulization to the upper stomach because of a prior Heller myotomy and fundoplication for achalasia.