A 68-year-old asymptomatic woman was involved in an ongoing research study evaluating the performance of a circulating tumor DNA-based blood test for early cancer identification (DETECT study). An abnormal result led to positron emission tomography–CT, which showed focal radiotracer uptake at the gastroesophageal junction (Fig. 1). This was followed by upper endoscopy, which revealed a small subepithelial lesion (SEL) at the esophagogastric junction/gastric cardia (Fig. 2). EUS showed a well-defined 22-mm × 14-mm hypoechoic lesion arising from the muscularis propria layer of the esophagus (Fig. 3).