However, HGD lesions persistently recurred. After discussing the different treatment options with the patient, endoscopic submucosal dissection (ESD) was chosen as the option for definitive treatment and total esophagectomy was reserved in case of technical failure or relapse. For this purpose, she was referred to our department. Endoscopy showed BE with multifocal visible lesions and several scars from previous procedures. ESD was performed with the “tunnel” technique encompassing all the dysplastic lesions (with a 1cm gastric distal margin and a proximal margin at 6cm from the gastroesophageal junction). Despite extensive submucosal fibrosis, en-bloc circumferential excision of the entire segment was successfully achieved without adverse events. A detailed endoscopic video case of the procedure is presented. Histological analysis showed a 70x45mm specimen with extensive low- and HGD, completely resected (R0). The patient was discharged home 48 hours after the procedure on an 8-week course of oral corticosteroids. She developed a symptomatic esophageal stricture which resolved with 10 endoscopic balloon dilation sessions, 6 of which combined with submucosal injection of corticosteroids.EMR is traditionally the mainstay method to remove BE-associated visible lesions without invasive features, however piecemeal resections entail an increased risk of recurrence. ESD as salvage therapy for BE-related dysplasia or neoplasia is feasible for achieving en-bloc and R0 resection in larger lesions or poorly lifting lesions because of scaring, with an acceptable safety profile. Referral to an expert centre performing ESD should be considered for patients with recurrence or progression following EMR or ablation therapy.