Endoscopic submucosal dissection for premalignant lesions and noninvasive early gastrointestinal cancers

Figure 2 Endoscopic submucosal dissection procedure for adenoma with high grade dysplasia at cardia. A: Adenoma at cardia; B: View of the lesion from esophageal aspect; C: Endosonographic image of the lesion; D, E: Marking the borders of the lesion with needle knife and lifting it; F, G: Cutting the lesion circumferentially with endo-cut above Z line, in retroflexion; H: Dissection of the submucosal area; I: Appearance of the mucosa after the lesion being extracted; K: Microscopic view of the lesion; L: Histology: mucosa, muscularis mucosa and superficial submucosa of stomach (HE × 20). Adenoma structure including adenomatous epithelium formed by irregular glands at mucosa; M: Endoscopic view six months after the procedure.