'Banding EMR of this junctional lesion is not going to plan! Biopsies had diagnosed IMca at least but both EUS and CT had been reassuring.
WHAT WOULD YOU CONSIDER NEXT?
■ Inject below lesion and try again
It will not work here and (rarely works at all)
■ Change to a wider cap
Will not work!
■ Remove lesion by ESD
You are asking for trouble!
■ Bail and declare that lesion is beyond endoscopic cure
There is no shame in admitting when you are beaten!
Although EUS and CT had both been reassuring, this lesion is clearly tethered down to the oesophageal wall. The lesion is extending too deeply for endoscopic cure. Trying to 'push the boat out' by attempting removal by 'pull within the snare' technique or ESD will fail and will run the risk of perforation, potentially resulting in the upstaging of the lesion. Bail out !