Education  |   April 2017
Acquired Bronchoesophageal Fistula and Gastroesophageal Junction Mass
Author Notes
  • From the Department of Anesthesiology, Memorial Hermann Memorial City Medical Center, Houston, Texas.
  • Address correspondence to Dr. Hiller: hillerk2@yahoo.com
Article Information
Education / Images in Anesthesiology / Gastrointestinal and Hepatic Systems
Education   |   April 2017
Acquired Bronchoesophageal Fistula and Gastroesophageal Junction Mass
Anesthesiology 4 2017, Vol.126, 717. doi:10.1097/ALN.0000000000001523
Anesthesiology 4 2017, Vol.126, 717. doi:10.1097/ALN.0000000000001523
THIS image was obtained during endoscopy for palliative esophageal stenting under monitored anesthesia care. A large gastroesophageal junction mass (A) and orifice proximal to the right of this mass are shown in the accompanying image. The orifice is an acquired bronchoesophageal fistula (B) communicating with the right mainstem bronchus secondary to metastatic lung cancer.
This unprotected communication between the gastrointestinal tract and airway has significant anesthetic and airway management implications.1–3  Aspiration of stomach contents is a constant risk.1  Positive-pressure ventilation above the bronchoesophageal fistula is associated with the following1–3 : a large airway leak, resulting in the inability to deliver projected tidal volumes; and esophageal and gastric insufflation, increasing an inherent risk of aspiration and potential pneumonitis.1,2 
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