Endoscopic images of a multi-band mucosectomy (MBM) in a patient with Barrett's esophagus with a focal lesion with HGIN

(A) Overview of a 3 cm long segment of Barrett's esophagus.
(B) There is a subtle lesion in the center of the endoscopic image.
(C) View after placement of electrocoagulation markers to delineate the lesion.
(D) A transparent cap with six rubber bands at its outside (identical to a variceal six-shooter) has been attached to the distal tip of the endoscope (Wilson-Cook Medical, Limerick, Ireland). The two wires to which the rubber bands are connected pass through the working channel of the endoscope and are connected to the handle that allows release of the bands.
(E) The area of interest is suctioned into the cap, without prior submucosal injection, followed by the release of one of the black rubber bands.
(F) The modified handle of the MBM device allows passage of a hexagonal polypectomy snare alongside the wires of the ligator. The snare is closed either above or below the rubber band followed by cutting using electrocoagulation.
(G) The wound after resection.
(H) The specimen is retrieved for histological assessment. Histology showed HGIN. The lateral and deep resection margins were free of dysplasia.