Naohisa Yahagi, MD, performs an endoscopic submucosal dissection of circumferential Barrett's Esophagus with diffuse nodular high grade dysplasia. This patient is a 66-year-old man with hypertension, high cholesterol and long-standing GERD. He had an endoscopy to evaluate new onset IRON deficiency anemia. An endoscopy in September 2018 showed LA class C reflux esophagitis which on biopsies revealed Barrett's esophagus with HGD. Repeat endoscopy in November 2018 showed 2cm hiatal hernia and 8cm Barrett's esophagus with diffuse nodular HGD. Confocal endomicroscopy finings consistent with dysplastic changes. This video is part of the 11th Annual Long Island Live Endoscopy Course, Frontiers of Endoscopic Surgery.