Endoscopic submucosal dissection for premalignant lesions and noninvasive early gastrointestinal cancers

Figure 4 Endoscopic submucosal dissection procedure for pseudo-depressed type lateral spreading tumor with high grade dysplasia at rectum. A: Pseudo-depressed type lateral spreading tumor at rectum; B: Cutting the lesion circumferentially with endo-cut; C, D: Submucosal dissection with semipermeable cap; E: Endoscopic view just before completing submucosal dissection; F: Appearance of the mucosa after the lesion being extracted; G: Microscopic view of the lesion; H: Histology; tubulovillous adenoma including fields of focal pattern loss and dysplasia (HE × 20); I: Endoscopic view ten weeks after the procedure.