Something has gone a little wrong here...

This is something of an enigmatic image of significant problem.  It may not look like a problem .. 
WHAT DOES IT SHOW?

■ Barrett's oesophagus

Of course!

■ Local recurrence at anastomosis

It IS an anastomosis !

■ Fistula

Fistula's are usually very obvious in the oesophagus but difficult to spot in the rectum

■ Squamous dysplasia

That is normal squamous mucosa !

explanation

The trick is to work out what's happened!   Of course, this patient has undergone an 'Ivor-Lewis' oesophagectomy for oesophageal adenocarcinoma. Unfortunately, the surgical anastomosis between the mid-oesophagus and the 'gastric tube' wasn't quite high enough and the surgeon has left a small patch of Barrett's behind.  Potentially a ticking time bomb ! 

Fortunately, it should be possible to remove this small patch of Barrett's by either an EMR or RFA.  I think that the Barrett's is a little too nodular (histology reported LGD), and we therefore opted for an EMR rather than RFA.