1. Management of High-Grade Dysplasia in Patients With Barrett’s Esophagus 
Elizabeth Montgomery, Marcia Irene Canto 
Clinical Gastroenterology and Hepatology 
Volume 4, Issue 12, Pages (December 2006)
DOI: /j.cgh
Copyright © 2006 AGA Institute Terms and Conditions

2. Figure 1
Endoscopic image of BE with subtle mucosal irregularity at the site of HGD.
Clinical Gastroenterology and Hepatology 2006 4, DOI: ( /j.cgh )
Copyright © 2006 AGA Institute Terms and Conditions

3. Figure 2
Endoscopic images of endoscopic mucosal resection (EMR). (A) Injection of saline into the submucosa to raise the mucosa, (B) suction of the target lesion into the cap attached to the tip of the endoscope, followed by closure of snare, and (C) after resection of the lesion with electrocautery, the EMR site shows submucosa with no bleeding or free perforation.
Clinical Gastroenterology and Hepatology 2006 4, DOI: ( /j.cgh )
Copyright © 2006 AGA Institute Terms and Conditions

4. Figure 3
Low-magnification image of the endoscopic mucosal resection performed in In this specimen, there is lesional tissue (intramucosal adenocarcinoma) at the lower right. Normal squamous mucosa is seen at the left portion of the field.
Clinical Gastroenterology and Hepatology 2006 4, DOI: ( /j.cgh )
Copyright © 2006 AGA Institute Terms and Conditions

5. Figure 4
Focus of intramucosal carcinoma. There is effacement of the lamina propria by atypical glands, many with intraluminal necrosis, although desmoplasia (stromal scarring pattern) is not present.
Clinical Gastroenterology and Hepatology 2006 4, DOI: ( /j.cgh )
Copyright © 2006 AGA Institute Terms and Conditions

6. Figure 5
Higher magnification of the intramucosal carcinoma; note the nucleoli in the proliferating cells. Nucleoli are not usually a feature of HGD.
Clinical Gastroenterology and Hepatology 2006 4, DOI: ( /j.cgh )
Copyright © 2006 AGA Institute Terms and Conditions

7. Figure 6
Zone of HGD adjoining the area of intramucosal carcinoma. The lamina propria, the zone containing lymphoplasmacytic cells, is readily identified, in contrast to that in Figure 4.
Clinical Gastroenterology and Hepatology 2006 4, DOI: ( /j.cgh )
Copyright © 2006 AGA Institute Terms and Conditions

8. Figure 7
High magnification of the image in Figure 6. There is loss of nuclear polarity (the cells have no orderly relationship to the basement membrane), but nucleoli are inconspicuous compared with those in Figure 5.
Clinical Gastroenterology and Hepatology 2006 4, DOI: ( /j.cgh )
Copyright © 2006 AGA Institute Terms and Conditions

9. Figure 8
Endoscopic image of distal esophagus 2 days after laser photoirradiation, showing the necrotic mucosa characteristic of photodynamic therapy effect.
Clinical Gastroenterology and Hepatology 2006 4, DOI: ( /j.cgh )
Copyright © 2006 AGA Institute Terms and Conditions

10. Figure 9
Endoscopic image of the patient’s distal esophagus almost 3 years later, showing no endoscopic evidence of columnar mucosa (A). Biopies taken just distal to the neosquamocolumnar junction show no goblet cells but rather gastric cardiac-type columnar epithelium and squamous epithelium (B).
Clinical Gastroenterology and Hepatology 2006 4, DOI: ( /j.cgh )
Copyright © 2006 AGA Institute Terms and Conditions

11. Figure 10
A recent endoscopic mucosal resection specimen from our institution. There is squamous mucosa at both margins, and the lesion is in the center, consisting of hyperchromatic glands. The glands seen in the submucosal fat are benign esophageal submucosal glands.
Clinical Gastroenterology and Hepatology 2006 4, DOI: ( /j.cgh )
Copyright © 2006 AGA Institute Terms and Conditions