Underwater endoscopic submucosal dissection using conical hood and gel immersion for esophageal squamous cell carcinoma with anastomotic stricture after total pharyngolaryngectomy

Pharyngoesophageal defects after total pharyngolaryngectomy (TPL) are commonly reconstructed with free jejunum or anterolateral thigh flap (ALT), often resulting in anastomotic stricture [1]. Endoscopic treatment of superficial esophageal squamous cell carcinoma (ESCC) in the presence of such an anastomotic stricture is challenging and requires ingenuity of devices and scopes [2]. Endoscopic submucosal dissection (ESD) with water or gel immersion helps in difficult-to-treat situations [3] [4], and the utility of a small-caliber tapered conical hood during ESD is established [5]. Herein, we describe underwater ESD with a conical hood and gel immersion, which was performed successfully for superficial ESCC with post-TPL anastomotic stricture ([Video 1]).