Development of Barrett's Esophagus Soon after Total Gastrectomy

The role of duodenal reflux and the time required for the development of Barrett's esophagus has remained controversial. We report a case of Barrett's esophagus that developed 6 months after total gastrectomy. A 76-year-old man diagnosed with gastric adenocarcinoma underwent a total gastrectomy and a Rouxen-Y esophagojejunostomy. The gastroesophageal junction in the resected specimen was both grossly and microscopically normal at the time of the operation. A routine follow-up endoscopic examination performed 6 months later revealed a tongue-like projection of redcolored columnar tissue. No reflux symptoms (heartburn or acid regurgitation) had been present during the intervening 6 months. A biopsy specimen from the esophagus showed intestinal-type metaplasia of the columnar epithelium. This case supports the development of Barrett's esophagus solely from duodenal reflux and after a relatively short time in this clinical setting.