Successful esophageal endoscopic submucosal dissection with a transoral endoscope after stepwise scope bougienage of post-endoscopic submucosal dissection stricture

Endoscopic submucosal dissection (ESD) for extensive esophageal cancer inevitably causes a post-ESD stricture. It may be difficult to perform additional ESD if a new lesion develops on the anus side of the post-ESD stricture. We sometimes perform balloon dilation of post-ESD stricture in advance, so we could perform ESD using a transoral scope; however, there is a risk of balloon dilation causing severe tearing of the lesions if it is located near the stricture. A 68-year-old man who had undergone ESD for esophageal cancer several times was diagnosed with early esophageal cancer. The lesion was located near the anus side of the post-ESD stricture. Unfortunately, the lesion was located on another post-ESD scar. Although ESD using a transnasal scope was a useful option, it was expected to be challenging as the submucosal layer was thought to have severe fibrosis. We attempted to perform ESD with a transoral endoscope after stepwise scope bougienage of post-ESD stricture.