The squamous portion of this oesophagus looks very unusual !
WHAT IS THE LIKELY REASON FOR THIS APPEARANCE?
■ Previous reflux disease
Nope, that's not it!
■ Previous EMR
Gives a pale scar, usually covered with squamous mucosa
■ Previous RFA
Absolutely. You've also seen it?
■ Previous radiotherapy
Gives telangioectatic vessels!
This patient had undergone RFA, leaving the squamous mucosa looking a little odd. It's actually the openings of the 'oesophageal glands' which you can see. In my experience, there is no point in taking any samples as histology will be reported as normal. In most cases, Barrett's returns at the gastro-oesophageal junction. The return is slow and subtle and for this reason you should take samples from what appears to be the 'columnar side' of the squamo-columnar junction. As intestinal metaplasia (Goblet cells to you and me) are common at the cardia, the pathologists will not be able to tell you if the Barrett's is returning. However, they CAN tell you if the epithelium look dysplastic again!
In a minority of cases, perhaps 1:4 the recurrence happens below the squamous mucosa which can be very hard to see. Of course, the only way to deal with 'buried Barrett's', is to remove the patch by EMR!