Early squamous neoplasia of the oesophagus is often very difficult to appreciate with white light endoscopy alone. This patient was referred for assessment of acid reflux symptoms and the referring centre had taken random oesophageal biopsies which reported features consistent with atypia. With enhanced imaging and i-scan, there is an extensive circumferential lesion with abnormal vasculature and mucosal irregularity. With lugol’s chromoendoscopy the extent of the lesion is further appreciated with extensive areas of oesophageal unstaining.
Courtesy of Dr. Rehan Haidry, UCLH, UK