Acquired Double Barrel Esophagus in the Setting of Barrett’s

Abstract

Introduction: Acquired double barrel esophagus, or esophagogastric fistula, is a rare endoscopic finding that has been reported in association with esophagogastric surgery, esophageal ulcer, epidermolysis bullosa dystrophica, and esophageal carcinoma. We report a case of esophageal remodeling with formation of 2 esophageal lumens in a patient with chronic reflux esophagitis and Barrett’s metaplasia. A 65-yearold male with a history of GERD (on BID Omeprazole) presented with progressively worsening dysphagia to solids, daily heartburn, and an unintentional 10-lb weight loss x 18 months. Barium esophagram revealed a longitudinal filling defect with mucosal abnormalities in the distal esophagus (Figure 1). EGD revealed a 6-cm segment of BE (C4M6), a 3-cm hiatal hernia, and extensive scarring in the distal esophagus with mucosal bridging and formation of 2 lumens in the distal 3 cm of the BE (Figure 2). Esophageal biopsies were consistent with reflux esophagitis, extensive goblet cell intestinal metaplasia, and negative for dysplasia or malignancy. Esophageal dilation was performed with improvement in symptoms. Repeat EGD with needle-knife resection of the mucosal bridge is planned in the future if dysphagia persists. In this case, the formation of an acquired esophagogastric fistula was likely due to chronic, ulcerative esophagitis with deep ulcer formation followed by granulation tissue overgrowth. Our case demonstrates a rare finding of esophageal tissue remodeling in the setting of reflux esophagitis and goblet cell metaplasia.Figure 1: Barium esophagram with mucosal abnormalities in distal esophagus.Figure 2: Endoscopic view of distal esophagus with scarring and mucosal bridging with formation of 2 lumens.