CONCLUSION AND RESULT:
Patient was prescribed long-term high-dose proton pump inhibitors
(PPIs). He was advised to adhere to a soft diet regimen. His symptoms
markedly improved 8 weeks following anti-secretory therapy and he was
well-tolerating soft diet. A barium swallow was subsequently done which
revealed normal passage of contrast material throughout the esophagus
and stomach with no evidence of extravasation or leakage of contrast
media (Figure 3). A repeat endoscopy demonstrated fusion of the
fistulous tract with the distal esophageal lumen with no evidence of
fistulous stoma upon endoscopic retroflexion in the gastric cardia
(Figure 4). The Nissen fundoplication remained intact. Patient remained
on PPIs and was switched to regular diet thereafter. Six months later,
patient underwent a repeat barium esophagogram which was again normal
and did not demonstrate any leakage of contrast media (Figure 5),
corroborating a complete resolution of the EGF. Patient remained
asymptomatic, performed well clinically and had good tolerance to
regular diet.