Insulated tip knife tunneling technique with clip line traction for safe endoscopic submucosal dissection of large circumferential esophageal cancer

Esophageal endoscopic submucosal dissection (ESD) is technically challenging for the following reasons: (1) the narrow lumen of the esophagus makes gravity countertraction less effective; (2) the resected specimen retracts distally, making it difficult to maintain good traction and orientation; and (3) the thin wall of the esophagus increases the risk of perforation.1 We describe a case of successful ESD of a large circumferential squamous cell cancer (SCC) by the use of an insulated tip (IT) knife tunneling technique with clip line traction.