To date, the primary mechanism for EGF development has not been fully elucidated given the rarity of the entity. Many mechanisms have been described in the formation of EGF. GERD and peptic ulcers are thought to trigger the mucosal erosion of the gastric fundus and favor its fistulization into the distal esophagus [1]. Surgery has been documented to contribute to the formation of EGF by inducing ischemia and necrosis by means of the strangulating sutures employed surgically [1]. Full-thickness suture bite is conducive to perforation and fistula formation [1]. Furthermore, pledgets used during surgery can erode into the distal esophagus and gastric fundus following LARS [1].