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Friends of Endoscopy is all about pattern recognition.  See it today and recognise it tomorrow!   Learn from a New Case on most weekdays !!! 
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A most odd appearance!

26/3/2021

Comments

 
Picture
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!
explanation
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! 
Comments

    Categories

    All
    Barrett's
    Cancer
    Cancer Syndromes
    Colitis
    Colorectum
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    Crypt Pattern
    Difficulty: Hard
    Difficulty: Moderate
    Difficulty: Very Hard
    Duodenum
    Eosinophilic Oesophagitis
    EUS
    Foveolar Metaplasia
    Gastric
    Gastroscopy
    GI Bleeding
    Histology
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    Ileum
    Immunosuppression
    Infection
    Local Recurrence Of Barrett's Ca.
    Lymphoma
    Mixed Polyp
    Mucosal Prolapse Syndrome
    NET
    Non-lifting Sign
    Oesophagus
    Opinion Piece!
    Pharynx
    Polyp
    Polypectomy
    The Basics
    TSA

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