Circumferential oesophageal endoscopic submucosal dissection (ESD) is technically feasible but frequently inefficient. Although tunnelling and traction strategies improve standard ESD, their benefit in circumferential resections is uncertain. We developed a novel double-tunnel traction (DTT) technique to improve stability and submucosal exposure. This study compared DTT with conventional ESD (cESD).Circumferential oesophageal endoscopic submucosal dissection (ESD) is technically feasible but frequently inefficient. Although tunnelling and traction strategies improve standard ESD, their benefit in circumferential resections is uncertain. We developed a novel double-tunnel traction (DTT) technique to improve stability and submucosal exposure. This study compared DTT with conventional ESD (cESD).

We performed a retrospective analysis of a prospectively maintained registry of ESDs for Barrett’s or squamous neoplasia between September 2017 and August 2025. Circumferential cases were analysed, comparing DTT with cESD overall and with traction (C+T) or without traction (C–T). Outcomes included dissection speed (min/cm²), R0 excision, recurrence and adverse events.

Among 320 oesophageal ESDs, 51 (15.9%) were circumferential (15 DTT, 36 cESD). Median defect length was 100 mm (range 40–200 mm), with similar baseline characteristics between groups. DTT achieved shorter procedure times than cESD (120 vs 160 minutes; P=0.009) and faster dissection speed (2.16 vs 3.33 min/cm²; P<0.001). Dissection speed remained superior to both C+T (3.56 min/cm²; P<0.001) and C–T (3.07 min/cm²; P=0.004). En-bloc resection was achieved in all DTT cases. R0 excision was numerically higher with DTT than cESD (86.7% vs 63.9%) and significantly higher than C+T (52.6%; P=0.035). Luminal recurrence was 0% with DTT versus 20.6% for cESD (P=0.076) and 27.8% for C+T (P=0.031). Adverse events were similar between groups.

Compared with conventional ESD, DTT improves efficiency and oncological outcomes with regard to R0 excision and luminal recurrence, without compromising safety. DTT offers a reproducible approach for these technically challenging resections.