This is something of an enigmatic image of significant problem. It may not look like a problem ..
WHAT DOES IT SHOW?
■ Barrett's oesophagus
■ Local recurrence at anastomosis
It IS an anastomosis !
Fistula's are usually very obvious in the oesophagus but difficult to spot in the rectum
■ Squamous dysplasia
That is normal squamous mucosa !
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.