Whole circumferential endoscopic submucosal dissection of superficial adenocarcinoma in long-segment Barrett's esophagus: A case report

Figure 4 Images of intraoperative endoscopy. A: Barrett's esophagus-related neoplasia appears to spread up to the gastric cardia. Endoscopic submucosal dissection (ESD) was started in this cardiac area; B: After resecting and dissecting the cardiac lesion, three submucosal tunnels were created from the oral side (black arrow is the first tunnel); C: A clip with a thread was attached to the mucosal edge of each of the three tunnels, and the dissected tissue of the tunnels was pulled toward the oral side (yellow arrow); D: Whole circumferential ESD had been completed. Steroid solution was injected into the remaining submucosa (white spots) immediately after ESD to prevent postoperative stenosis.