High-level intraepithelial neoplasia of the esophagus is a precancerous lesion, indicating the appearance of early esophageal cancer, which requires prompt treatment. The mucosa of the esophagus is covered with a layer of squamous epithelium, which protects the esophagus. In reflux esophagitis, this disease can cause damage to the esophageal mucosa and even prolonged erosion, and long-term disease can lead to atypical hyperplasia of the squamous epithelium. High-grade esophageal intraepithelial neoplasia is a kind of in situ cancer, but the disease is relatively limited and has not yet invaded the submucosa of esophagus, and no lymph node metastasis has occurred, so it is the best time for treatment. Patients with high-grade esophageal intraepithelial neoplasia should be treated with mucosal debulking surgery (ESD) as soon as possible and, if necessary, combined with radiotherapy to inhibit tumor spread.