A 60-year-old patient has a bulky lesion in the distal esophagus, measuring 20 to 25 millimeters. Assessment includes evaluating the pit and vascular pattern, with dysplasia noted. Imaging shows no muscular or nodal involvement, allowing for endoscopic resection. Various techniques like ESD and tunneling are discussed, emphasizing the importance of accurate marking for visibility during the procedure to ensure successful intervention.