Haruhiro Inoue, MD, performs an ESD of T1 barrett’s adenocarcinoma. The patient is a 79 year old woman with CHF, Biventricular ICD, atrial fabulation on Xarelto, s/p cardioversion x 2, asthma, interstitial lung disease, moderate pulm HTN, CKD, Iron, deficiency anemia, lymphoma s/p chemo and stem cell transplant, hypothyroidism presents for management of early Barrett’s adenocarcinoma. EGD for dyspepsia in December 2019 revealed LA Grade D reflux esophagitis between 36-38cm. Biopsies showed squamous mucosa with HGD. She had 4 weeks of high dose reflux therapy and had repeat endoscopy. This video is part of the 11th Annual Long Island Live Endoscopy Course, Frontiers of Endoscopic Surgery.