We present a 73-year-old patient with multiple cardiovascular comorbidities, unfitfor surgery, diagnosed with Barrett’s esophagus (C3M6) with visible lesions (ParisIIa, IIc, Is) and high-grade dysplasia (HGD). The patient underwent endoscopic submucosal dissection (ESD) for suspected submucosal invasion. Histopathology revealed G2 adenocarcinoma (pT1b sm2) with intestinalmetaplasia and extensive HGD, but no lymphovascular invasion, with clear margins(R0). Post-procedure, esophageal stricture required multiple dilations. Surveillance gastroscopy identified a new adenocarcinoma (pT2Nx, R0), managed by full-thickness resection and stenting. Nine months post-treatment, the patient remains recurrence-free. This case underscores advanced endoscopic techniques asorgan-sparing solutions for high-risk patients.