Endoscopic submucosal tunnel dissection for large superficial esophageal squamous cell neoplasms

Figure 4 Double-tunnel endoscopic submucosal tunnel dissection for circumferential superficial esophageal neoplasms. A: An 8 cm circumferential superficial esophageal cancer was showed by iodine staining, at 28–36 cm from the incisors; B: Circular incisions were successively performed at the anal and oral margins after marking; C, D: Two submucosal tunnels were created opposite each other. Two tunnels nearly covered the whole esophageal lumen, and the borders were narrow enough to be resected easily; E: A 14 cm retrievable, fully-covered esophageal stent was placed to prevent postoperative stenosis. F: The lesion was resected circumferentially, about 60 mm in length. From Zhai et al[20].