Fig. 1.

(A) Upper endoscopy with lugol solution reveals an unstained area in the lower esophagus. The superficial esophageal carcinoma involves almost the whole circumference of the esophageal lumen. (B) Circumferential markings are made by a hook knife just outside the lesion. (C) Precutting is made with a hook knife. (D) Near-circumferential endoscopic submucosal dissection is performed. (E) Triamcinolone is injected into the deep submucosa and the superficial proper muscle layer of the ulcer base. (F) The tumor is removed en bloc.