Lesion found at the gastro-oesophageal junction
SHOULD I ATTACK OR ABORT?
INCORRECT. SOMETHING HORRIBLE IS LURKING BELOW!
CORRECT, THERE IS A HORRIBLE LOOKING ULCERATED CANCER SEEN AT CARDIA
From above this looks like a reactive nodule, perhaps secondary to reflux. Naturally, one couldn't rely on a visual inspection and an EMR seemed indicated. However, on retrovertion (bottom right image), the true nature of the lesion is revealed. There is a depressed, indurated area just at the GOJ (the close-up image at the bottom on the left show some irregular, malignant looking vessels). I diagnosed a type III early gastric cancer (Sievert's type III guess) probably involving the muscle propria (T2 disease) and organised an EUS. Surprisingly, the subsequent EUS upstaged the lesion to T3,N0,M0). I find it tricky to "stage" lesions at the cardia. Even small lesions can be far more advanced that expected.