A 67 year-old white female was referred for evaluation of anemia and occult GI bleeding. An EGD revealed a polypoid pre-pyloric lesion that was removed by snare. Histopathology revealed well differentiated adenocarcinoma that did not arise from an underlying adenoma. A repeat endoscopy was done to remove tissue at the base by endoscopic mucosal resection (EMR). Three injections of 7–10 cc of saline were used to lift the base from the submucosa. No residual cancer was seen in the mucosa or submucosa of the base tissue removed during EMR.. Subsequent endoscopic ultrasound was unremarkable for gastric wall or regional lymph node abnormalties. The Japanese classification of this lesion is Type I-protruded. Mucosal cancer is seldom associated with lymph node metastases, whereas submucosal cancer has lymph node metastatic rates of 10–40%. It is the possibilty of lymph node invasion that is the most serious limitation of EMR. Surgical series of resected early gastric cancer demonstrate that lymph node involvement can be correlated to the diameter and depth of the superficial gastric tumor, in addition to histology. It can be stated that EMR is indicated in the resection of superficial early gastric cancer when the cancer is well differentiated, limited to the mucosa, and less than 20 mm in diameter. While such lesions are often found in Japan, only four have been reported in the US. This represents the first such lesion treated in a community hospital. This aggressive form of endoscopic therapy is safe and effective and avoids surgery and it’s associated morbidity and mortality. It is attractive because of a demand for minimally invasive procedures in the US, and because the rare association of these lesions with lymph node metastases and long term studies showing EMR patient outcomes similar to surgery.