Aortoesophageal fistula: early and late endoscopic features

Endoscopic photographs were obtained in a patient with back pain and hematemesis. External compression of the mid-esophagus and small esophageal diverticula was noted, as well as a small erosion oozing bright red blood in otherwise normal mucosa. Angiography revealed an aneurysm of the thoracic aorta without leak. Surgical closure of the aneurysm was initially successful; however, the patient developed recurrent bleeding one month later. Repeat endoscopy revealed a recurrent fistula with an intramural mass in the mid-esophagus, oozing blood with adherent clot. These findings are the earliest endoscopic features of aortoesophageal fistula described, and this is the only case with subsequent reendoscopy, demonstrating previously reported findings in an advanced stage of fistula formation. Flexible endoscopy is a safe, valuable diagnostic study in suspected aortoesophageal fistula. The literature on endoscopy in aortoesophageal fistula is reviewed.