Esophageal stricture secondary to a large circumferential squamous lesion removed by multi-tunnel endoscopic submucosal dissection

A 56-year-old female presented with food impaction. From 16 to 29 cm from the incisors, we visualized a circumferential IIb lesion that prevented the passage of the conventional gastroscope. We made a first submucosal tunnel up to 29 cm from the incisors. Submucosal dissection of the stenotic area (fibrotic and highly vascularised) allowed subsequent access to the distal margin so that we could carry out the distal circumferential incision. We then performed two additional parallel submucosal tunnels. We used traction (clip+thread) to facilitate dissection of the intertunnel submucosa. Size: 130x30mm. Histology:pT1a squamous cell carcinoma with lymphovascular invasion.