“…Perforation during esophageal endoscopic submucosal dissection (ESD) can lead to severe complications; localized muscle defects can result in large perforations during ESD that require surgery 1 . While the effectiveness of endoclips or over-the-scope clip systems (OTSC; Ovesco Endoscopy AG, Tübingen, Germany) for the closure of small perforations is well recognized, there is a limit to the size of defect they can close 2 .…”