INTRODUCTION:
Esophago-gastric fistula (EGF) is an exceedingly rare entity. Many
etiologies have been associated with the development of EGF:
gastroesophageal reflux disease (GERD), esophagogastric surgery,
fistulizing Crohn’s disease, esophageal ulcers and carcinoma [1].
Interestingly, laparoscopic Nissen fundoplication, a procedure commonly
used to treat refractory GERD, has also been associated with the
formation of EGF.
Different theories have been posited in terms of the connection between
Nissen fundoplication and EGF development. Intraoperative injuries,
compromised blood supply leading to ischemic necrosis and migration of
the fundic wrap are plausible etiologies behind EGF development.
Treatment of EGF can be conservative through medical management with
anti-secretory drugs, such as proton pump inhibitors (PPIs). When
conservative management fails, endoscopic modalities are utilized, such
as tissue sealants, stenting and endoscopic clipping. Surgery remains
the cornerstone treatment for EGF. However, we herein describe a case of
EGF post-laparoscopic Nissen fundoplication that was successfully
resolved by virtue of conservative medical treatment with long-term
high-dose PPIs.