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Esophageal subepithelial lesions (SELs) are common in endoscopy practice. Clinical management depends on multiple factors including tissue diagnosis and, thus, assessment of malignant potential [1]. With respect to endoscopic resectability and, if appropriate, choice of therapeutic modality, characterization of the layer of origin is critical. However, as conventional low-frequency endosopic ultrasound (EUS) may not reliably determine the origin of amuscularis mucosae lesion, for example, clear-cut differentiation of the muscularis propria and nonmuscularis propria localization is more relevant. From this perspective, apart from granular cell tumors, which have a high rate of tissue diagnosis on standard forceps biopsy, EUS puncture is often discussed, but is also often technically complicated in small-sized lesions. Therefore, a more straightforward approach in easy-to-resect nonmuscularis propria lesions may be more appropriate, given adequate patient counseling and preference. Here, a novel variant technique, which is an evolution of endoscopic submucosal resection with ligation (ESMR-L) and is designated “double ligation-assisted endoE-Videos

Double ligation-assisted endoscopic submucosal resection for wider-margin resection of nonmuscularis propria subepithelial esophageal lesions