Asks
Six years of GERD, Barrett without dysplasia, three months of trouble swallowing solids. Barium swallow shows a symmetric, concentric narrowing of the distal esophagus. Most likely cause, and the definitive treatment?
You, out loud
“Barrett’s is progressing — I think this is adenocarcinoma of the distal esophagus. I’d scope him and biopsy it.”
Grade
Miss
Barrett is why you reached for cancer, but the barium finding decides it: malignant strictures are asymmetric and irregular. Symmetric and concentric is a peptic stricture — scarring, not dysplasia. Endoscopy is right, and it is also the treatment: dilation, plus high-dose PPI so it does not re-form.
Gap logged — “assumed malignancy from Barrett history, ignored stricture morphology”