LAUSR

Figure 2. CT displayed an 11-cm giant tumor from the pharyngeal pyriform sinus, which extended intraluminally to the middle esophagus (red dotted circle). Hypopharyngeal and esophageal liposarcomas are very rare and are mainly diagnosed as pedunculated submucosal tumors. Mobile pedunculated tumors of the hypopharynx have the risk of causing airway obstruction and should hence be extracted. Here, we report a rare case of a patient in whom endoscopic submucosal dissection (ESD) with countertraction using grasping forceps was performed for a giant pedunculated pharyngeal liposarcoma. The patient was a 75-year-old man who presented to our hospital because of difficulty swallowing. Upper GI endoscopy and CT displayed a 11-cm large pedunculated submucosal tumor with a smooth surface on the posterior hypopharyngeal wall, which extended intraluminally to the middle esophagus (Figs. 1A and B and 2). In addition, a 2-cm lipoma was detected in the right postcricoid area. WeperformedESD to remove the giant pedunculated submucosal tumor with the patient under general anesthesia to avoid the risk of airway obstruction (Video 1, available online at www.VideoGIE.org). First, a curved rigid laryngoscope (Nagashima Medical Instruments Co, Ltd, Tokyo, Japan) was inserted to provide a working space in the pharyngeal lumen. We then pulled the mobile pedunculated tumor to the oral side with the orally inserted curved grasping forceps (Nagashima Medical Instruments Co, Ltd) (Fig. 3A and B). After injecting saline solution into the subepithelial layer and while maintaining