Endoscopic submucosal dissection (ESD) is commonly performed for (pre)cancerous lesions in the esophagus. Following ESD, post-procedural chest pain is seen in many patients. Studies have shown that local bupivacaine (BP) into the residual submucosal layer of the resection wound after gastric ESD could reduce post-procedural pain rates effectively. Levobupivacaine (LB) is equipotent to BP regarding analgesic effects, but has a better safety profile. No studies have been performed to evaluate the efficacy of LB after esophageal ESD to reduce pain. Therefore, we want to evaluate the effect on post-procedural pain of local application of LB during esophageal ESD.

Inclusion Criteria:

• Patients age ≥18 years at time of consent
• Visible lesion in the esophagus, minimum diameter of the lesion ≥20 mm
• Scheduled for esophageal ESD
• Informed consent

Exclusion Criteria:

• Presence of multiple lesions requiring two or more separate endoscopic resections
• History of esophageal surgery other than fundoplications
• History of esophageal ablation therapy
• History of radiotherapy of the esophagus
• Esophageal varices
• Prior endoscopic resection in the same area
• Uncontrolled coagulopathy
• Severe medical comorbidities precluding endoscopy
• Allergy to LB or other amide-type local anaesthesia
• Current regular use of opioids
• Other aetiology causing pain similar to post-ESD pain
• Inability to assess pain due to severe psychiatric or neurological disease
• Insufficient command of Dutch language
• Brugada syndrome
• Incapacitated patients