Inclusion Criteria:

Patients referred for endoscopic treatment of advanced
gastrointestinal (colorectal, gastric, duodenal, esophagus) neoplasia, defined by any of
the following procedures:

1. Flat dysplastic lesion greater than 2cm(IIa or IIb by Paris classification)

2. Flat depressed lesion < 2cm in size (llc by Paris Classification)

3. Ulcerated lesion < 2cm (Paris type lll) staged as T1N0 on endoscopic ultrasound

4. Upon resection, the criteria for curative ESD include:

- Non-invasive neoplasia of differentiated carcinoma

- No lymphovascular invasion

- Intramucosal cancer or minute submucosal cancer <1 mm invasion (sm1)

- Negative deep and lateral margins.

Exclusion Criteria:

1. Use of antiplatelet(e.g. clopidrogel) or anticoagulation (e.g. Coumadin) agents that
cannot be withheld for at least 7 days prior to the procedure. Aspirin use is
accepted according to the American Society for Gastrointestinal Endoscopy for these
procedures.

2. Patients who refuse or who are unable to consent.

3. Suboptimal colon prep, or solid gastric residual that precludes safe lesion resection
at the time of endoscopy.

4. Lesion location in a segment of the colon not conducive to ESD, including significant
narrowing, tortuosity and/or extensive diverticular disease, as determined by the
endoscopist.