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Endoscopic submucosal dissection for giant esophageal lipomatous tumors. BACKGROUND AND AIM: Thoracotomy is the foremost choice of giant esophageal lipomatous tumors in previous studies, but it is highly traumatic and possibly diminishes the quality of patients' lives. To minimize such impacts, a minimally invasive method without loss of curability is desirable for giant lipomatous tumors of the esophagus. With recent progress in endoscopic techniques and devices, endoscopic submucosal dissection (ESD) has been successfully used to remove esophageal or gastric submucosal tumors. In our study, we aimed to evaluate the clinical impact of ESD for giant esophageal lipomatous tumors. METHODS: Design, single-center, retrospective study; setting, academic medical center; patients, six patients with six giant lipomatous tumors of the esophagus between February 2013 and December 2020; interventions, ESD; and main outcome measurements, procedure duration, en bloc resection rate, complications, local recurrence, and distant metastases. RESULTS: Endoscopic en bloc resections of esophageal lipomatous tumors were successfully performed in all patients, with a mean duration of 56.5 ± 26.0 min. All en bloc resection lesions showed both lateral and deep tumor-free margins. The average maximum diameter of the esophageal lipomatous tumors was 171.7 ± 66.2 mm. No complications such as bleeding and perforations happened during hospitalization with 4.0 ± 1.6 days. Besides, local recurrence and distant metastasis have not occurred during the follow-up period. CONCLUSIONS: Endoscopic submucosal dissection is a safe and effective way to dissect giant lipomatous tumors of the esophagus thoroughly.